Laser Eye Research: Peer Reviewed Publications

Journal of Refractive Surgery, 2009;25(11):975-978
Dan Z. Reinstein, George O. Waring III

This editorial describes improvements to the Standard Graphs for Reporting Refractive Surgery Outcomes originally described by GO Waring in 2000. It also sets out the commitment of the Journal of Refractive Surgery to enforce the use of this standard to ensure that outcomes are reported comprehensively and that direct comparison between papers is possible.

Journal of Refractive Surgery, Available at www.journalofrefractivesurgery.com/preprint.asp Posted online November 16, 2009
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe

This paper demonstrates how the epithelium becomes thinner centrally and thicker paracentrally as a result of hyperopic LASIK to compensate for the ablation of stromal tissue. Knowledge of epithelial thickness changes helps extend the range of treatment in hyperopic treatment and increases the safety of higher corrections.

Journal of Refractive Surgery, Available at www.journalofrefractivesurgery.com/preprint.asp Posted online March 11, 2010
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe

This paper reports monocular and binocular outcomes of LASIK with a micro-monovision protocol and using a non-linear aspheric ablation profile to increase depth of field in patients with presbyopia and moderate to high myopia. Binocularly, 99% of patients achieved 20/20 and could read J5. There was no reduction in mesopic contrast sensitivity at all spatial frequencies.

Journal of Refractive Surgery, Available at www.journalofrefractivesurgery.com/preprint.asp. Posted online January 28, 2010
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe

Ablation depth was measured as the change in stromal thickness using the Artemis; the most accurate method of measuring stromal change. The MEL80 was found to overestimate the achieved ablation depth by approximately 20 microns. Linear regression equations could be used to adjust the ablation depth for predicting residual stromal thickness. A knowledge of ablation depth increases the long-term safety of high myopic treatments. Accurate calibration of the ablation depth of an excimer leaser enables safe treatment of higher levels of myopia.

Journal of Refractive Surgery, Available at www.journalofrefractivesurgery.com/preprint.asp Posted online November 16, 2009
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe, Ronald H. Silverman, D. Jackson Coleman

The Artemis very high-frequency digital ultrasound arc-scanner showed very high repeatability for measuring the epithelium, stroma, cornea, flap and residual stromal bed (RST), for both point repeatability and region repeatability. The Artemis has the highest repeatability compared with all current publications for all other instruments available. The Artemis technology is a unique technology for measuring epithelial thickness, flap thickness and residual stromal bed thickness (RST) in 3D. Where other technologies are capable of measuring flap and residual stromal thickness at certain points within the cornea, they have significantly inferior accuracy to the Artemis technology.

Journal of Refractive Surgery, 2009; 25:604-610
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe

This paper describes how the epithelial thickness profile can be used to differentiate between normal and keratoconic corneas in cases where a diagnosis is uncertain based on the most modern topographic and tomographic screening techniques alone. An epithelial doughnut pattern appears to indicate the presence of an underlying stromal cone. The use of epithelial thickness profile appears to allow an earlier diagnosis of keratoconus. This enables surgeons to treat cases that topographically would otherwise have been rejected for LASIK, as well as exclude cases in which topographic diagnosis alone would have suggested suitability for LASIK.

Journal of Refractive Surgery, 2009;25:569-577
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe

This paper describes LASIK outcomes in a group of eyes with suspect keratoconus on topography where the diagnosis of keratoconus was excluded using epithelial thickness profile mapping, and in a matched control group. There were no statistically significant differences between the two groups and none of the eyes developed ectasia, providing evidence that epithelial thickness mapping enables LASIK to be performed in cases which would otherwise have been excluded for surgery.

Journal of Refractive Surgery, 2010, Apr;26(4):259-271
Dan Z. Reinstein, Sabong Srivannaboon, Marine Gobbe, Timothy J. Archer, Ronald H. Silverman, D. Jackson Coleman

Keratoconus eyes demonstrated a specific epithelial thickness profile characterised by an epithelial doughnut pattern with localized central thinning surrounded by an annulus of thick epithelium. Knowledge of the epithelial, stromal and corneal thickness profiles might help diagnose keratoconus earlier.

Journal of Refractive Surgery, 2010, Feb;26(2):107-19
DZ Reinstein, TJ Archer, M Gobbe, N Johnson

The VisuMax femtosecond laser system was found to create flaps with an accuracy of +2.3 µm and a reproducibility of 7.9 µm. Analysis of a review of all current publications on flap thickness accuracy and reproducibility demonstrates that the Visumax is the most accurate device currently available. The excellent accuracy and reproducibility of the Visumax together with Artemis layered thickness measurements enables custom flaps to be created in complex cases, and enables the safe creation of ultra-thin flaps for the treatment of very high prescriptions without the haze and tissue healing risks associated with surface procedures (PRK, LASEK, Epi-LASIK).

Optom Vis Sci 2009;86(8):E1006-1014
DZ Reinstein, TJ Archer, M Gobbe, D Couch, B Bloom

In this case report, the Artemis very high-frequency digital ultrasound scanner was used to produce 3D pachymetric maps of the epithelium, stroma and cornea; these showed that refractive changes during orthokeratology treatment were mainly induced by changes in epithelial thickness profile, while stromal changes might contribute to a small extent. These findings show that contrary to current opinion, it will not be possible to use corneal cross-linking to extend the effects of orthokeratology beyond the current stability of 12-24h.

Ultrasound Med Biol, 2009, 35(5):839-846
RH Silverman, MS Patel, O Gal, A Sarup, A Deobhakta, H Dababneh, DZ Reinstein, EJ Feleppa, and DJ Coleman

The main cause of inaccuracy of ultrasound based thickness measurements within the cornea is related to changes in hydration. This paper describes hydration-dependent changes in the speed-of-sound and frequency-dependent stromal acoustic backscatter and attenuation in ex vivo cow corneas. These results can be used to calculate the potential error in an ultrasound system. The results demonstrate that changes in hydration are negligible when using high-frequency ultrasound for corneal pachymetry.

Journal of Refractive Surgery, 2009, Feb;25(2):185-94
Dan Z. Reinstein, Timothy J. Archer, Ronald H. Silverman, Mark J. Rondeau, D. Jackson Coleman

Most of the major complications of phakic IOLs relate to incorrect sizing of the implant. The sizing of phakic IOLs that are placed inside the normal eye is currently based on estimating the internal dimensions of the eye. In this study, we found using univariate and multivariate Regression Analysis that only weak correlations exist between the white-to-white corneal diameter, the angle diameter and the sulcus diameter. The study also demonstrated that direct measurement of angle diameter and sulcus diameter rather than estimation based on the white-to-white diameter would increase the safety of phakic IOL sizing. We concluded that the safety of the ICL and other phakic IOL technologies could be significantly improved if surgeons used direct measurements of the posterior chamber dimensions, as opposed to estimates based on indirect measurements.

Journal of Refractive Surgery, 2009, Jan;25(1):37-58
Dan Z. Reinstein, Darren G. Couch, Timothy J. Archer

We developed a method of treating presbyopia together with hyperopia and astigmatism. Based on the increase in of depth-of-field afforded by a controlled change in the aberrations of the cornea in hyperopic LASIK, we developed a technique called Laser Blended Vision for hyperopia (including high hyperopia) with astigmatism. This paper reports the outcomes of hyperopic LASIK with our Laser Blended Vision micro-monovision protocol in patients with presbyopia and hyperopia up to approximately +6.00 D with astigmatism. At 1 year, 94.5% of patients achieved 20/20 and could read J5 binocularly.

Journal of Refractive Surgery, 2009;25(5):444-450
Dan Z. Reinstein, Sabong Srivannaboon, Marine Gobbe, Timothy J. Archer, Ronald H. Silverman, Hugo Sutton, D. Jackson Coleman

This is the first ever published paper characterise the thickness profile of the epithelium of the human cornea before and after myopic LASIK. This paper demonstrated that the epithelium thickened in a lenticular fashion after myopic LASIK across the central 6 mm of the cornea, with maximum thickening centrally and progressively less thickening centrifugally. The profile of epithelial thickening was different for low, moderate and high myopia which indicates that the myopic refractive shift due to epithelial profile changes varies with the level of myopia. We demonstrated that paradoxically, the refractive effect of epithelial remodelling is more significant in lower myopia than higher myopia – a totally unexpected finding.

Journal of Refractive Surgery, 2009;25(9):776-786
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe, Ronald H. Silverman, D. Jackson Coleman

This paper describes three-dimensional thickness mapping of the stroma and stromal thickness profile in a normal population. One interesting finding was that absolute stromal thickness progression was independent of central stromal thickness which means that percentage thickness progression – as used by some keratoconus screening tomography devices [Pentacam and Visante] could in some cases be misleading. Knowledge of the stromal thickness profile in the normal population might help in early diagnosis of corneal abnormalities such as keratoconus, thus avoiding LASIK in cases where long-term safety could be compromised though the development of post-LASIK ectasia.

Journal of Refractive Surgery, 2009, 25(6):503-515
Dan Z Reinstein, Timothy J. Archer, Marine Gobbe

This paper assesses the efficacy, safety, and accuracy of TOSCA II (Topography Supported Custom Ablation) treatments for the correction of high corneal aberrations and refractive error following previous ocular surgery. Case examples include the optical zone recentration, optical zone enlargement and reduction of high spherical aberration. Topography-guided treatment results are compared and shown to be more effective than wavefront-guided treatment in the correction of complications of corneal refractive surgery including LASIK, PRK (LASEK, Epi-LASEK, Epi-LASIK), RK (radial keratotomy) and corneal transplants (PK, DALK).

Journal of Refractive Surgery, 2008, 24(6):571-581
Dan Z. Reinstein, Timothy J. Archer, Marine Gobbe, Ronald H. Silverman, D. Jackson Coleman

It is unusual to be able to publish an anatomy paper in the first decade of the new millennium. However, the thickness profile of the epithelium of the human cornea had never been described, and was thought to be an even thickness laser of tissue. In our study, Artemis based 3D thickness mapping of the corneal epithelium demonstrated that the epithelial thickness is not evenly distributed across the cornea as was previously assumed; the epithelium was 5.9 µm thicker inferiorly than superiorly and 1.3 µm thicker nasally than temporally with a larger infero-superior difference than naso-temporal difference. These differences are important to know, in particular as they can adversely affect the symmetry of stromal ablation in no-touch trans-epithelial PRK (LASEK, Epi-LASEK, Epi-LASIK).

Journal of Refractive Surgery, 2007, 23(5):442-446
Sabong Srivannaboon, Dan Z. Reinstein, Timothy J. Archer

This paper showed that there was no statistically significant change in higher order aberrations of patients measured by Zywave aberrometer throughout the day. This showed that the B&L Zywave aberrometer does not possess the accuracy or reproducibility in order to show the changes in aberrations that have been show to occur during the day [e.g. http://eprints.qut.edu.au/2819/].

Ophthalmic Surgery, Lasers and Imaging, 2006, Nov-Dec;37(6):486-488
AA Moshfeghi, SA Harrison, DZ Reinstein, PJ Ferrone

This case report describes a case of Valsava-like retinopathy 15 hours after bilateral hyperopic LASIK. It is likely that the pathology was caused by the rapid rise and fall of intraocular pressure during the microkeratome and suction ring combined with a valsalva-like maneuvre of the patient during application of the suction ring. The patient was treated and recovered fully.

Journal of Refractive Surgery, 2006, Nov;22(11):861-870
Dan Z. Reinstein, Sabong Srivannaboon, Timothy J. Archer, Ronald H. Silverman, Hugo Sutton, D. Jackson Coleman

This paper describes a statistical model that may be used as a tool for surgeons to evaluate the risk of ectasia due to excessive keratectomy depth and help determine the minimum target RST to use given the particular microkeratome, excimer laser, and pachymeter.

Journal of Refractive Surgery, 2006, Nov;22(11):851-860
Dan Z. Reinstein, Sabong Srivannaboon, Timothy J. Archer, Ronald H. Silverman, Hugo Sutton, D. Jackson Coleman

This paper used the model which we developed for the inaccuracy of corneal depth in LASIK to demonstrate that the choice of microkeratome, excimer laser, and pachymeter has a significant impact on the calculation of the residual stromal thickness and thus on the risk of ectasia. The model shows that certain microkeratomes were more than 1,000 times safer than others in terms of their chances of inducing ectasia by LASIK. The model aims to reduce the risk of ectasia by enabling the surgeon to determine the specific imprecision of RST calculation for individual cases.

Journal of Refractive Surgery, 2006, November;22(9):843
Dan Z. Reinstein and George O. Waring III

This editorial discusses the current evidence for the long-term safety of LASIK and in particular the risk of ectasia. The editorial provides evidence from keratomileusis and early LASIK studies that reassure us that there is no concern for the safety of modern LASIK in the long-term.

Journal of Cataract and Refractive Surgery, 2006, Nov;32:1883-1887
Dan Z. Reinstein, Darren G. Couch, Timothy J. Archer

This case report describes the use of Artemis very-high frequency digital ultrasound to directly measure the residual stromal thickness (RST). Direct measurement found the RST to be unsafe for retreatment although a retreatment would have been performed based on the predicted RST calculation alone. This case highlights the imprecision of the predicted RST calculation and the associated risk of ectasia. Accurate direct measurement of RST would assist surgeons in determining suitability for LASIK enhancement procedures and preventing iatrogenic ectasia.

Journal of Cataract and Refractive Surgery, 2006, Nov;32:1870-1876
Dan Z. Reinstein, Timothy J. Archer

This case report demonstrates how an accurate epithelial thickness map can provide a diagnosis for visual disturbances that could not be explained by conventional topography and wavefront screening. This case demonstrates that the epithelium will remodel itself to compensate for stromal irregularities. The epithelial thickness map can then be used to optimize the smoothing effect of transepithelial PTK ablation for the treatment of a highly complex optical surface.

Journal of Cataract and Refractive Surgery, 2006, Nov;32:1799-1802
Dan Z. Reinstein, Timothy J. Archer, Ronald H. Silverman, D. Jackson Coleman

This paper reports good accuracy, repeatability, and reproducibility of measurement of lateral dimensions using the Artemis very high-frequency (VHF) digital ultrasound arc scanner. The repeatability coefficient was 0.114 mm. The reproducibility coefficient was 0.026 mm. The repeatability CV was 0.38%, and the reproducibility CV was 0.09%. These results confirm that the Artemis can be used to reliably obtain measurements of the dimension of the anterior segment.

Journal of Cataract and Refractive Surgery, 2006, Nov;32:1877-1882
Dan Z. Reinstein, Richard C. Rothman, Darren G. Couch, Timothy J. Archer

This case report describes the use of Artemis very-high frequency digital ultrasound to map the thickness profile of a free cap and residual stromal bed. The correct orientation of the free cap was determined using a computer simulation to rotate the stromal component of the free cap until a lock and key fit was found. Such mapping of the layers of the cornea is not possible with any other currently available instrument.

Journal of Refractive Surgery, 2006, May;22(5):431-440
Dan Z. Reinstein, Hugo Sutton, Sabong Srivannaboon, Ronald H. Silverman, Timothy J. Archer, D. Jackson Coleman

This paper describes a new technique of measuring flap thickness and studying flap thickness profile, which takes into account postoperative edema and epithelial changes. The technique describes the Reinstein Flap Thicknes, which is the only method of determining the actual flap thickness produced by a microkeratome or femtosecond laser. Knowledge of flap thickness characteristics such as accuracy and reproducibility for microkeratomes could significantly benefit the accuracy and safety of LASIK.

Journal of Refractive Surgery, 2006, March;22(3):268-274
Dan Z. Reinstein, Timothy J. Archer, Darren Couch

This paper evaluated the accuracy of myopic refraction using the WASCA aberrometer. The correlation between manifest refraction and WASCA refraction was good although there were some outliers. These results confirm the WASCA to be the most accurate aberrometer currently available.

Journal of Refractive Surgery, 2006, March;22(3):285
Dan Z. Reinstein and Cynthia Roberts

This editorial discusses current knowledge about biomechanical properties of the cornea and its impact on corneal refractive surgery.

Optom Vis Sci, 2005, Dec;82(12):1047-1053
Han B. Fam, Kooi L. Lim, Dan Z. Reinstein

This paper describes the repeatability of pachymetry with the Orbscan. The repeatability was comparable to that of ultrasound pachymetry for central measurements but became poorer towards the periphery.

Survey of Ophthalmology, 2005, Nov-Dec;50(6):549-587
Carlo F. Lovisolo, and Dan Z. Reinstein

This review on phakic intra-ocular lenses presents a historical description of different types of anterior and posterior phakic IOL as well as surgical techniques. It focuses on sizing issues and safety guidelines.

Journal of Refractive Surgery, 2005, Sept-Oct;21(9):S535-S540
Dan Z. Reinstein, Timothy J. Archer, Darren Couch, Eckhard Schroeder, Matthias Wottke

Some investigators suggest that pupil size does not matter with respect to night vision disturbances after corneal laser eye surgery (LASIK, PRK etc.) This paper suggests a new single metric, the RAWS parameter, to describe overall higher order aberrations over a range of pupil sizes, demonstrating that pupil size significantly affects spherical aberration of the eye after laser eye surgery and that spherical aberration correlates to loss of contrast sensitivity and subjective night vision disturbances. This paper uses the RAWS parameter to assess the success of wavefront-guided treatments in a case series of highly aberrated eyes following previous refractive surgery. The reduction in RAWS parameter correlated well with the improvement in contrast sensitivity demonstrating the success of the wavefront-guided procedure.

Journal of Refractive Surgery, 2005, Sept-Oct;21(9):480-484
Dan Z. Reinstein, Barbara Ameline, Michel Puech, Guy Montefiore, Laurent Laroche

This case report describes the use of layered pachymetric mapping with Artemis very-high frequency digital ultrasound to provide a diagnosis for myopic regression following multiple corneal refractive surgery procedures.

Journal of Cataract and Refractive Surgery, 2005, Jun;31(6):1153-1158
D. H. Lee, J. R. Oh, Dan Z. Reinstein

This study compared wavefront LASIK and conventional LASIK with a larger optical zone. The wavefront LASIK group showed less increase of coma and higher order aberrations than the conventional LASIK group. This indicated that wavefront guided ablation might be beneficial for the conservation of corneal tissue.

Journal of Refractive Surgery, 2004, Sept-Oct-Oct;20(9):454-464
Mark J. Rondeau, Gyorgy Barcsay, Ronald H. Silverman, Dan Z. Reinstein, Rupa Krishnamurthy, D. Jackson Coleman

Very-high frequency ultrasound was found to be accurate and precise for the measurement of anterior and posterior chamber diameter providing that the eye and head were stable during scanning. Individual variations in the population suggest that biometry is required for correct sizing and placement of anterior and posterior phakic IOLs.

Ophthalmol Clin North Am, 2004, Jun;17(2):191-210, vii. Review

This paper describes advances in technology using the Carl Zeiss Meditec platform. Custom ablation can be achieved using wavefront aberrometry (WASCA), corneal surface shape data (TOSCA), sophisticated excimer laser delivery (MEL80), and surgeon-controlled individualization of treatment protocol (CRS-Master). Together, these components promise to deliver increasingly higher accuracy and control over corneal sculpting.

Journal of Refractive Surgery, 2001, May-June;17:310-318
Dan Z. Reinstein, Sabong Srivannaboon, Simon P. Holland

Three-dimensional VHF digital ultrasound scanning was used to examine anatomical changes of the epithelium and stroma after Intacs implantation. This might help in understanding the mechanism of refractive effects.

Journal of Cataract and Refractive Surgery, 2001, Sept;27:1350-52
Dan Z. Reinstein, Ronald H. Silverman, Tatiana Raevsky, George J. Simoni, Harriet O. Lloyd, David J. Najafi, Mark J. Rondeau and D. Jackson Coleman

In this consultation section, we diagnosed the cause of corneal scarring and presented a similar case in which we coined the diagnosis of: “cryptic button-hole” as a complication of LASIK. This diagnostic entity is topical even now as many have described the occurrence of “gas breakthrough” during flap creation by femtosecond lasers. We describe the incidence of this complication and treatment options.

Journal of Refractive Surgery, 2000, Jul-Aug;16:414-30
Dan Z. Reinstein, Ronald H. Silverman, Tatiana Raevsky, George J. Simoni, Harriet O. Lloyd, David J. Najafi, Mark J. Rondeau and D. Jackson Coleman

This seminal paper describes the prototype to the Artemis system developed by Professor Dan Reinstein and colleagues at Cornell University for measuring the individual layers of the cornea using very high-frequency digital ultrasound arc scanning. The clinical prototype was designed to acquire layered corneal scan data from a 10 mm corneal diameter in 3D – the most high-definition non-invasive imaging system ever developed in the whole of medicine. The system was able to produce thickness mapping of the corneal epithelium, stromal component of the flap, and residual stromal layer after LASIK with unprecedented precision, which to date has not been replicated by other technologies including OCT (Optical Coherence Tomography).

Ophthalmology, 2000;107(4):640-52
Simon P. Holland, Sabong Srivannaboon, Dan Z. Reinstein

This paper reviewed cases which had severe complications in the early days of LASIK and PRK. The aim was to identify avoidable factors that may have contributed to these complications using B-scan cross-sections and layered pachymetry data obtained by Artemis VHF digital ultrasound technology.

Journal of Cataract and Refractive Surgery, 1999;25(12):1596-9
Sabong Srivannaboon, Dan Z. Reinstein, Hugo F. S. Sutton, Simon P. Holland

This paper demonstrates that the refractive change after LASIK was highly correlated with the corneal power change averaged within the 4-mm zone by the Orbscan total optical power maps. This was the first paper to suggest that corneal tomography could be use to improve on the accuracy of IOL power calculations after corneal refractive surgery, and formed the basis for research which has been carried out by many other researchers in this area of cataract surgery.

Institute of Electrical and Electronics Engineers (IEEE), Computer Graphics & Applications, 1999;19(4):74-82
Matthew D. Segall, Dan Z. Reinstein and Neil F. Johnson

This paper describes a software application to enhance the analytical power of VHF digital ultrasound scanning data of the human cornea.

Ophthalmology, 1999, Mar;106(3):474-82
Dan Z. Reinstein, Ronald H. Silverman, Hugo F. S. Sutton and D. Jackson Coleman

This paper demonstrated many previously unknown (but now generally accepted) factors relating to the healing of the cornea after LASIK or surface procedures (PRK, LASEK, Epi-LASEK, Epi-LASIK). The paper uses several cases to show that three-dimensional mapping of individual corneal layers is a sensitive method of providing a diagnosis when refractive and videokeratographic data are unable to explain the underlying cause for the optical complications.

Journal of Refractive Surgery, 1998, Nov-Dec;14(6):636-40
Sudi Patel, Dan Z. Reinstein, Ronald H. Silverman, D. Jackson Coleman

This paper estimated the shape of the anterior surface of Bowman’s layer and found that Bowman’s layer was steeper than the anterior corneal surface and had an hyperbolic shape. The significance of this is that it reversed the previously accepted dogma that the epithelium of the cornea did not contribute to the overall refractive power of the corneal lens structure.

American Journal of Ophthalmology, 1998, May;125(5):725-9
Daniel Kim, Dan Z. Reinstein, Ronald H. Silverman, David J. Najafi, Sandra Belmont, Alexander Hatsis, George Rozakis and D. Jackson Coleman

This paper demonstrates the use of very high-frequency digital ultrasound to image a phakic posterior chamber intra-ocular lens in situ, now known as the PRL (phakic refractive lens) and its relation to the ocular structures in the posterior chamber of the eye. It is the earliest work ever performed on imaging phakic IOLs within the living eye behind the iris to better understand the safety of inserting artificial lenses into the eye without removing the natural lens (i.e. without cataract surgery).

Ophthalmology, 1998, Feb;105(2):300-6
Andrea Cusumano, D. Jackson Coleman, Ronald H. Silverman, Dan Z. Reinstein, Mark Rondeau and Suzanne Woods

This paper demonstrates the use of three-dimensional ultrasound imaging associated with quantitative volume measurement and biometric techniques to enhance diagnosis and treatment of ocular diseases.

Journal of Ultrasound in Medicine, 1997, Feb;16(2):117-124
Ronald H. Silverman, Dan Z. Reinstein, Tatiana Raevski and D. Jackson Coleman

This was the first paper demonstrating the benefits of an arc-scanning technique over rectilinear scanning. Arc-scanning enabled the ultrasound transducer to maintain perpendiculatiry with the cornea which improved the accuracy of peripheral thickness measurements and allowed a much larger region of the cornea (8 mm) to be scanned and mapped.

Acoustical Imaging, 1997;23
Frederic L. Lizzi, Andrew Kalisz, Michael Astor, D. Jackson Coleman, Ronald H. Silverman and Dan Z. Reinstein

British Journal of Ophthalmology, 1996, Dec;80(12):1063-1067
John Danias, Ioannis M. Aslanides, Ronald H. Silverman, Dan Z. Reinstein and D. Jackson Coleman

This paper was the first detailed study of high frequency ultrasonic imaging of the iris in iridoschisis and gives evidence for there being an underlying genetic cause for iridoschisis (an abnormal splitting of iris tissue).

British Journal of Ophthalmology, 1995, Nov;79(11):972-6
Editorial commentary in: British Journal of Ophthalmology 1995; 79(11):967-9
Ioannis M. Aslanides, Peter E. Libre, Ronald H. Silverman, Dan Z. Reinstein, Douglas R. Lazzaro, Mark J. Rondeau, Gregory K. Harmon and D. Jackson Coleman

This paper demonstrated the use of high-frequency ultrasound imaging in making the diagnosis of pupillary block glaucoma.

CLAO Journal, 1995, Oct;21(4):268-72
Ioannis M. Aslanides, Dan Z. Reinstein, Ronald H. Silverman , Douglas R. Lazzaro, Mark J. Rondeau, Hanna S. Rodrigues and D. Jackson Coleman

This paper demonstrated the use of high-frequency ultrasound for the assessment of the internal microarchitecture of surgically altered corneal tissue and its healing dynamics.

Journal of Cataract and Refractive Surgery, 1995, Jul;21(4):398-401
Douglas R. Lazzaro, Ioannis M. Aslanides, Sandra C. Belmont, Ronald H. Silverman, Dan Z. Reinstein, Jacqueline W. Muller, Harriet O. Lloyd and D. Jackson Coleman

This paper demonstrated the use of high-frequency ultrasound to obtain high-definition images of the cornea post radial keratotomy and measure the depth of the incisions.

Journal of Refractive Surgery, [letter] 1995, May-Jun;11(3):162-4
Ioannis M. Aslanides, Minas N. Aslanides, Dan Z. Reinstein, Ronald H. Silverman and D. Jackson Coleman

This letter to the editor establishes that etymologically, the correct term for thickness measurement should be pachymetry, not pachometry as used by many authors.

CLAO Journal, 1994, Jul;20(3):198-203
Dan Z. Reinstein, Ioannis M. Aslanides, Ronald H. Silverman, Penny A. Asbell and D. Jackson Coleman

This paper demonstrated the use of high-frequency ultrasound to obtain corneal thickness measurements and epithelial and scar thickness measurements to help determine the optimal treatment strategy.

Ophthalmology, 1994, Mar;101(3):432-8
Dan Z. Reinstein, Ronald H. Silverman, Stephen L. Trokel, Mark J. Rondeau and D. Jackson Coleman

This was the first paper to describe a method of producing 3D maps of the individual layers of the cornea after LASIK or surface PRK employing very high-frequency digital ultrasound technology – an early precursor to the Artemis technology.

Ophthalmology, 1994, Jan;101(1):140-146
Dan Z. Reinstein, Ronald H. Silverman, Mark J. Rondeau , D. Jackson Coleman

This paper was the first study on human corneas to use very high-frequency digital ultrasound to accurately determine the central corneal and epithelial thickness of the human cornea. Hitherto, corneal thickness measurements of the human cornea had been performed with less accurate methods. This study also demonstrated how signal processing of the digitized ultrasound data improved measurement precision.

Ophthalmology, 1993, Sept;100(9):1351-7
Norma Allemann, Ronald H. Silverman, Dan Z. Reinstein, D. Jackson Coleman

This study was the first study to demonstrate tissue characterization analysis of ultrasound scans on an experimental model in rabbits, where a traumatic bleed was induced in the anterior chamber of the eye (hyphema).

Refractive and Corneal Surgery, 1993, Sep-Oct;9(5):385-7
Dan Z. Reinstein, Ronald H. Silverman, D. Jackson Coleman

This was the first paper to confirm the measurement of the epithelium of the cornea in vivo using a prototype rectilinear high-frequency ultrasound scanning system. This paper demonstrated that acoustic interfaces detected were indeed located spatially at the epithelial surface and the interface between epithelial cells and the surface of Bowman’s layer.

Archives of Ophthalmology, 1993, Jul;111(7):968-73
Norma Allemann, Wallace Chamon, Ronald H. Silverman, Dimitri T. Azar, Dan Z. Reinstein, Walter J. Stark, D. Jackson Coleman

This study was the first study to demonstrate tissue characterization analysis of ultrasound scans on an experimental PRK model in rabbits demonstrating that high-frequency ultrasound signal processing could be used to quantitatively grade the corneal haze induced by excimer laser PRK.

Archives of Ophthalmology, 1993, Apr;111(4):430-1
(published erratum appears in Arch Ophthalmol 1993 Jul; 111(7):926)
Dan Z. Reinstein, Ronald H. Silverman, Stephen L. Trokel, Norma Allemann and D. Jackson Coleman

This letter to the editor was the very first report of what at the time was a novel technique: digital signal processing of very high-frequency ultrasound B-scans of the cornea. In the letter, we demonstrated the use of high-frequency ultrasound to precisely determine the location and depth of scarring in a cornea, and showed how the measurements were useful for planning phototherapeutic keratectomy (PTK).

British Journal of Ophthalmology, 1993, May;77(5):293-6
Dan Z . Reinstein, Neil Dorward, Richard P. L. Wormald, Anna Graham, Ian O’Connor, Ruth Charlton, Mark Yeatman, Ronald Dodenhoff, Robin Touquet, Teresa Challoner

This paper reported that a significant degree of Correctable Undetected Visual Acuity Deficit could be detected using a simple procedure (pinhole) which can be carried out by general practitioners as part of their general elderly health screen. The study found that over one-third of patients over 65 attending the A&E department at St. Mary’s Hospital had a significant deficit in the vision correction glasses that they were wearing.

British Journal of Psychiatry, 1991, Apr;158:554-7
Gary T. Bell, Dan Z. Reinstein, Girma Rajiyah, Rachel Rosser

This paper reported results of screening A&E patients at University College Hospital for psychiatric disturbances including anxiety and depression, demonstrating that accident patients were more likely to have a higher anxiety of depression score than attendees who were admitted for non-accidental causes.