The Accuracy of Flap Thickness Versus the Pre-determined Surgical Planning Using WaveLight® FS200
Conditions: Myopia
Sponsor: Stephen Wexler

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The accuracy of flap thickness versus the pre-determined surgical 
planning using WaveLight® FS200 
An investigator-initiated clinical trial 
1.  TITLE PAGE 
 
Protocol Number: 
SW-22-001  
Amendment Number 
Version 2.0 
IRB / ERC 
Salus IRB 
2111 West Braker Lane, Suite 400 
Austin, Texas 78758 
 
 
Sponsor Name & Address: 
Stephen A. Wexler, MD 
Refractive Surgery Specialists, LLC 
620 N 9th St, Bismarck, ND 58501 
 
(funding only, this is an investigator-initiated study 
IIT # 73058121) 
Alcon  
6201 South Freeway,  
Fort Worth, TX 76134-2099, USA  
 
 
Test Articles: 
WaveLight® FS200 femtosecond laser 
 
  Investigator:  
 
  Stephen A. Wexler, MD 
 
 
 
 
 
 
 
 

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2 . INVESTIGATOR AGREEMENT 
 
I confirm that I have read and that I understand this protocol entitled “The 
accuracy of flap thickness versus the pre-determined surgical planning using 
WaveLight® FS200”, and understand the use of the study products. I agree to 
conduct this study in accordance with the requirements of this protocol and also 
protect the rights, safety, privacy, and well-being of study subjects in accordance 
with the following: 
 
• 
The ethical principles that have their origin in the Declaration of Helsinki. 
• 
All applicable laws and regulations, including, without limitation, data privacy 
laws and regulations. 
• 
Regulatory requirements for reporting serious adverse events defined in Section 
13 of this protocol. 
 
 
 
 
Signature of Investigator  (Date) 
 
Investigator Name (print or type) 
 
Investigator’s Title 
 
Name of Facility 
 
Location of Facility (City) 

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3.  GENERAL INFORMATION 
 
Objective 
To compare the intended flap thickness defined by pre-op 
planning to the achieved flap thickness obtained. 
 
The hypothesis is that the WaveLight® FS200 is able to create 
accurate flap thickness and diameter versus pre-determined 
surgical planning. 
 
Test Article(s)   
WaveLight® FS200 femtosecond laser  
Control Article(s) 
None. 
 
Sample size  
110 eyes of 55 subjects 
Study Population 
Subjects ≥18 years of who are appropriate candidates for laser 
refractive surgery.  
 
Number of sites 
One 
Study Design 
Single site, single-arm, prospective, observational study 
Masking 
None 
Variables 
Primary:  The resultant thickness of the FS200 created LASIK 
flap compared to plan at the surgical visit. 
 
Secondary: 
• The resultant diameter of the FS200 created LASIK flap 
compared to plan.  
• Pre-operative Pachymetry as measured by the EX500 
versus the Oculus Pentacam. 
 
Duration / Follow-up 
Preoperative to 1 day postoperative  
 
The study will be registered with clinicaltrials.gov.  
 
The study will be conducted in compliance with the protocol, GCP and applicable 
regulatory requirements 
 

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4.  TABLE OF CONTENTS 
1.  TITLE PAGE .............................................................................................................................. 1 
2 . INVESTIGATOR AGREEMENT .................................................................................................. 2 
3.  GENERAL INFORMATION ........................................................................................................ 3 
4.  TABLE OF CONTENTS .............................................................................................................. 4 
5.  INTRODUCTION ...................................................................................................................... 6 
6.  OBJECTIVE(S) .......................................................................................................................... 6 
7.  SUBJECTS ................................................................................................................................ 6 
7.1. Subject Population ...................................................................................................... 6 
7.2. Inclusion Criteria ......................................................................................................... 6 
7.3. Exclusion Criteria ......................................................................................................... 7 
8.  STUDY DESIGN ........................................................................................................................ 7 
8.1. Study Design ................................................................................................................ 7 
8.2. Methods Used to Minimize Bias .................................................................................. 8 
9.  STUDY PROCEDURE ................................................................................................................ 8 
9.1. Informed Consent / Subject enrollment ..................................................................... 8 
9.2. Visits and Examinations ............................................................................................... 8 
9.3. Study Methods and Measurements .......................................................................... 10 
9.4.  Unscheduled Visits ................................................................................................... 10 
9.5.  Discontinued Subjects .............................................................................................. 10 
10.  ANALYSIS PLAN ................................................................................................................... 11 
10.1. Analysis Data Sets .................................................................................................... 11 
10.2. Statistical Methodology .......................................................................................... 11 
10.3. General Statistical Considerations .......................................................................... 11 
11.  SAMPLE SIZE JUSTIFICATION .............................................................................................. 11 
12. CONFIDENTIALITY/PUBLICATION OF THE STUDY ................................................................ 11 
13.  QUALITY COMPLAINTS AND ADVERSE EVENTS .................................................................. 12 
13.1. General Information ................................................................................................ 12 
13.2. Monitoring for Adverse Events ............................................................................... 12 
13.3. Procedures for Recording and Reporting AEs and SAEs .......................................... 12 
13.4. Follow-Up of Adverse Events and Quality Complaints ............................................ 15 

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13.5. Safety Analyses ........................................................................................................ 15 
14. GCP, ICH and ETHICAL CONSIDERATIONS ........................................................................... 16 
14.1 Confidentiality .......................................................................................................... 16 
15.  STANDARD EVALUATION PROCEDURES ............................................................................. 16 
Table 15.1. Proposed Visits and Study Assessments ........................................................ 17 
16. CONFIDENTIALITY ................................................................................................................ 17 
17. FINANCIAL AND INSURANCE INFORMATION/STUDY RELATED INJURIES ............................ 17 
18. STUDY ENDPOINT CRITERIA ................................................................................................ 18 
18.1. Patient Completion of Study ................................................................................... 18 
18.2. Patient Discontinuation ........................................................................................... 18 
18.3. Patient Termination ................................................................................................ 18 
18.4. Study Termination ................................................................................................... 18 
18.5. Study Completion .................................................................................................... 18 
19. SUMMARY OF RISKS AND BENEFITS .................................................................................... 18 
19.1. Summary of risks ..................................................................................................... 18 
19.2. Summary of benefits ............................................................................................... 18 
REFERENCES .............................................................................................................................. 19 
 
 
 

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5.  INTRODUCTION 
The predictability of corneal flap thickness is critical in planning and producing 
successful LASIK outcomes.1 Flaps that have been made too thin or too thick can 
contribute to the safety of the procedure.1 The femtosecond laser has rapidly evolved to 
become a widely adopted technology for surgeons performing laser assisted in-situ 
keratomileusis (LASIK) surgery.1  
 
A previous study has provided evidence of the predictability and lower variability of 
LASIK flaps created using femtosecond laser and of the accuracy of flap-thickness 
measurements using the inbuilt optical pachymeter.1 In another study, the intended flap 
diameters and achieved flap diameters showed extremely high precision.2 This suggests 
the predictability and lower variability of LASIK flaps created using the femtosecond 
laser. However, there is little clinical trial data to support these studies and to demonstrate 
reproducibility. 
6.  OBJECTIVE(S) 
To evaluate the resultant thickness of the FS200 created LASIK flap compared to plan at 
the surgical visit. 
7.  SUBJECTS 
7.1. Subject Population  
Eligible test subjects will be 18 years of age or older and who are interested in and 
appropriate candidates for LASIK.  
 
A total of 110 eyes of 55 subjects at one site will be enrolled. Both eyes of a subject must 
be enrolled. Subjects must meet the inclusion criteria. Prior to enrollment, subjects will 
be provided information on the study and asked to sign a patient information and consent 
form to participate. The patient information and consent form will be approved by an 
appropriate ethics committee. 
7.2. Inclusion Criteria 
Subjects are eligible for the study if they meet the following criteria: 
Note: Ocular criteria must be met in both eyes. 
• Appropriate candidate for uncomplicated bilateral LASIK surgery  
• Gender: Males and Females.   
• Age: 18 or older.  
• Refractive error range - SE refractive errors up to 0 to -6D with maximum 
cylinder up to 3.00D  
• Stable refractive error <0.50D change in preceding year  
• Contact lens wear discontinued 3 days prior to pre-op exam and the procedure 

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• Pachymetry above 490µm with residual greater than 270µm 
• Candidates who, as determined by the investigator, can safely undergo LASIK 
with a 120µm flap  
• Willing and able to provide written informed consent for participation in the 
study.  
• Willing and able to comply with scheduled visits and other study procedures.   
• Have good general and ocular health, with no pathology that compromises visual 
acuity (outside of residual refractive error)  
7.3. Exclusion Criteria 
If any of the following exclusion criteria are applicable to the subject or either eye, the 
subject should not be enrolled in the study. 
• Patients with usual relative and absolute contraindications for LASIK surgery 
(severe dry eye, recurrent corneal erosion, uncontrolled Glaucoma, collagen 
vascular disorders, keratoconus or signs of keratoconus, uncontrolled Diabetes, 
Herpes) 
• Pachymetry below 490µm 
• Autoimmune or immunodeficiency diseases 
• Patients with signs of inability to understand consent for study and procedure 
planned 
• Patients with history of previous ocular surgery 
The principal investigator reserves the right to declare a patient ineligible or non-
evaluable based on medical evidence that indicates they are unsuitable for the trial.  
 
Pregnancy has a known effect on the stability of refractions and visual acuity. As such, 
subjects who become pregnant during the study will not be discontinued but their data may 
be excluded from analyses of effectiveness. 
8.  STUDY DESIGN 
8.1. Study Design  
This study is a Single site, single-arm, prospective, observational study of the accuracy of 
the intended flap thickness, after successful bilateral LASIK surgery. Subjects will be 
assessed pre-operatively, operatively and at 1 day post-operatively. Clinical evaluations 
will include measurement of visual acuity, manifest refraction, and flap thickness, and 
flap diameter. 
 
The primary outcome measure will be the resultant thickness of the FS200 created 
LASIK flap compared to plan at the surgical visit. 
 

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Secondary outcome measures are as follows: 
• The resultant diameter of the FS200 created LASIK flap compared to plan.  
• Pre-operative Pachymetry as measured by the EX500 versus the Oculus Pentacam  
 
8.2. Methods Used to Minimize Bias  
As a single-arm study there is no expected bias. Patient selection will be based on the 
patient’s interest and the surgeon’s opinion as to whether they are a suitable candidate for 
LASIK. 
 
The measurement of visual acuity will be conducted in a systematic fashion to minimize 
bias. Individuals conducting visual acuity measures will be instructed to perform the 
same testing in the same fashion for all subjects, with the same level of encouragement to 
subjects.  
 
All data collection will be completed through provided Case Report Forms (CRFs) or 
computer files generated by automated test equipment. All site personnel involved in the 
study will be trained in regard to conducting study-specific procedures. 
9.  STUDY PROCEDURE  
9.1. Informed Consent / Subject enrollment  
No subject will be enrolled into the study who does not meet the inclusion/exclusion 
criteria and does not sign the current approved informed consent document. Informed 
consent will be obtained prior to collecting any data for the study. The original signed 
documents will be maintained by the investigator as a permanent part of the subject's 
medical records. A signed copy will be provided to the subject.  
9.2. Visits and Examinations  
Subjects will participate in 3 study visits, including one visit for bilateral surgery. Visits 
will include an uptake visit, and one operative visit (Visit numbers 1-2 below).  The visit 
schedule, complete with window and associated CRF forms, are displayed in Table 9.2-1.  
Details of each study visit, including testing to be conducted, are provided below.  
 
 
 
 

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Table 9.2-1.  Visit Schedule 
 
Visit 
Number 
Visit Name 
Visit Window 
CRF 
Number 
1 
Preoperative  
-60 to 0 days from surgery 
1 
2 
Operative 
0 from surgery 
2 
 
 
9.2.1. Preoperative  
 
At the preoperative exam, subjects will be consented, qualified for the study 
(compared with inclusion/exclusion criteria), and assigned a study ID/subject 
number.  Subject numbers will be assigned sequentially at each site in the order of 
enrollment. Pre-operative qualification should take place no more than 60 days 
prior to surgery.   
 
A medical history will be taken and exams will include the tests described below: 
§ manifest refraction, 
§ visual acuity, 
§ pachymetry, 
§ horizontal white-to-white 
In addition, all site-specific, routine, usual standard of care preoperative measures 
should be undertaken.   
 
Measurements should be made as described in section 9.3 below.  
 
9.2.2. Operative (Surgery) 
 
All subjects will undergo bilateral LASIK surgery. The surgeon’s usual standard 
of care with regard to treatment and medication will be used for all study subjects. 
Surgery planning will be performed using the surgeon’s preferred method. 
 
Surgical findings will be recorded and will include the tests below: 
§ EX500 pachymetry measurement before flap lift.   
§ EX500 pachymetry measurement after flap lift but before ablation 
treatment. 
§ Measurement of flap diameter compared to plan. 
 
Any adverse events/serious adverse events (AEs/ SAEs) occurring during surgery 
will be noted at this visit. Any other problems during surgery and comments 
regarding surgery will be documented.  

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Any subject whose surgery is not completed successfully will be documented in 
the appropriate case report form. These subjects will be monitored for safety but 
clinical performance data may be excluded from the analysis. 
 
9.2.3. Exit Procedures 
In the event of premature exit from the study, all study related examinations 
should be completed where possible. The Exit CRF should be completed, noting 
that the subject did not complete the study and the reason for premature study 
exit.  If no premature exit from the study occurs, the Exit CRF should be 
completed at the end of Visit 2.  
 
9.3. Study Methods and Measurements 
All routine testing and basic eye examinations should be carried out at each study visit.  
Abnormalities should be recorded in the CRF “Comment” section.  Specific study 
examination procedures are outlined below.  
 
 
9.3.1. Manifest Refraction 
Perform a manifest refraction with a high contrast Snellen chart under photopic 
lighting conditions.  Document refraction results with sphere, cylinder and axis 
readings.  If uncorrected visual acuity is not improved by manifest refraction, use 
zero for sphere and cylinder and draw a line through the blank for the axis.  
 
Note:  Each subject should be manually refracted to his/her best correction by an 
ophthalmologist, optometrist, or a skilled technician using a phoropter or trial 
lenses.   
 
 
9.3.2. Visual Acuity (VA) 
Distance VA 
Measure distance visual acuity using a high contrast Snellen chart under photopic 
lighting at a distance of 20 ft.   
 
9.4.  Unscheduled Visits 
Unscheduled exams may be conducted at the discretion of the Investigator with all 
relevant information from the exam recorded in the source documents and on the 
Unscheduled Visit pages within the CRF booklet. 
9.5.  Discontinued Subjects 
Discontinued subjects are those who do not have an exit visit or who come into the office 
to be exited prior to the scheduled final study visit. Subjects may be discontinued from 
the study at any time if, in the opinion of the investigator, their continued participation in 
the study poses a risk to their health. The reasons for discontinuation include: 
a. Adverse event; 

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b. Lost to follow-up; 
c. Subject decision unrelated to an adverse event; 
d. Protocol violation; 
e. Treatment failure; 
f. Other. 
To ensure the safety of all subjects who discontinue prior to Visit 3, investigators should 
assess each subject and, if necessary, advise them of any therapies and/or medical 
procedures that might be needed to maintain their health. Any changes in medical health 
and/or use of concomitant medications should also be captured. 
10.  ANALYSIS PLAN 
10.1. Analysis Data Sets 
All subjects who are enrolled in the study will be evaluated for safety.  Efficacy analyses 
will be performed based on data from those eyes with uncomplicated LASIK surgery.   
10.2. Statistical Methodology 
A summary of the data will be prepared for all measurement time points.  
 
For variables measured on a continuous scale, these summaries will include the sample 
size, as well as the mean, standard deviation, median, minimum, and maximum. For 
variables measured on a categorical scale, summaries will provide the number and 
percentage of subjects in each category. These summaries will be provided for all eyes 
completing the study. 
 
10.2.1. Within-treatment Changes 
For variables measured on a continuous scale, the statistical significance of each 
parameter will be investigated using a paired t-test.  
10.3. General Statistical Considerations 
The statistical analyses will be performed using R, version 4.1.2 or higher.  Any 
statistical tests of hypotheses will employ a level of significance of alpha=0.05. 
11.  SAMPLE SIZE JUSTIFICATION 
We estimate that the study would require a sample size of at least 49 patients (98 eyes) to 
achieve a power of 90% and a level of significance of 5% (two sided), for detecting a 
mean of the differences of 5µm between pairs, and assuming the standard deviation of the 
differences to be 15µm. For additional power of the study and for any possible patients 
that leave the study prematurely, we are recommending a total of 55 patients (110 eyes). 
12. CONFIDENTIALITY/PUBLICATION OF THE STUDY 
The existence of this Study is confidential and should not be discussed with persons 
outside of the Study. Results will be submitted for publication and presentation at 
national and/or international meetings. A manuscript will be submitted to peer-review 
journals for publication but there is no guarantee of acceptance. 

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All study data will be collected on appropriate Case Report Forms (CRFs). No protected 
health information will be included on the forms. CRFs will be retained in the patient’s 
file for a minimum period of 3 years. Collected information will only be used for 
purposes of this study and no information will be sold to third parties. The following 
people will have access to your study records:  
 
•    Study Doctor and staff involved with the study 
 
•    Study Monitor or Auditor 
 
•    Sponsor Company or Research Institution 
 
•    Review boards or accrediting agencies 
 
•    Other State or Federal Regulatory Agencies 
 
The de-identified data may be shared with other researchers for future analysis. 
13.  QUALITY COMPLAINTS AND ADVERSE EVENTS 
All subjects will be monitored for adverse events over the course of the study. A place to 
record any adverse event is included on each case report form. 
13.1. General Information 
An Adverse Event (AE) is any untoward medical occurrence in a subject who is 
administered. a study treatment regardless of whether or not the event has a causal 
relationship with the treatment. An AE, therefore, can be any unfavorable or unintended 
sign (including an abnormal laboratory finding), symptom, or disease temporally 
associated with the study treatment, whether or not related to the treatment. In clinical 
studies, an AE can include an untoward medical occurrence occurring at any time, 
including run-in or washout periods, even if no study treatment has been administered. 
13.2. Monitoring for Adverse Events 
At each visit, after the subject has had the opportunity to spontaneously mention any 
problems, the Investigator should inquire about AEs by asking if the patient has any 
problems.  
13.3. Procedures for Recording and Reporting AEs and SAEs 
Subsequent to signing an informed consent form, all untoward medical occurrences that 
occur during the course of the study must be documented on an Adverse Event Form 
(AEF). A separate AEF must be filled out for each event. When possible, signs and 
symptoms indicating a common underlying pathology should be documented as one 
comprehensive event. For each recorded event, the AE documentation must include the 
onset date, outcome, resolution date (if event is resolved), intensity (i.e., severity), any 

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action with study treatment taken as a result of the event, and an assessment of the 
adverse event’s relationship to the study treatment. 
Nonserious Adverse Events 
A nonserious AE is defined as any untoward change in a subject's medical health that 
does not meet serious criteria noted below (e.g., is not life-threatening, does not require 
hospitalization, does not prolong a current hospitalization, is not disabling, etc.). All 
adverse events must be reported regardless of whether or not they are related to the study 
treatment. 
 
For nonserious adverse events, an AEF containing all available information will be 
collected on a routine basis and submitted to the Medical Monitor at the close of the 
study.  
 
Serious Adverse Events 
A serious adverse event (SAE) is defined as any adverse experience that meets any of the 
following criteria: 
• 
Results in death. 
• 
Is life-threatening. 
NOTE: Life-threatening means that the subject was at immediate risk of death 
from the reaction as it occurred; i.e., it does not include a reaction which 
hypothetically might have caused death had it occurred in a more severe form. 
• 
Requires inpatient hospitalization or prolongation of existing hospitalization. 
NOTE: In general, hospitalization signifies that the individual remained at the 
hospital or emergency ward for observation and/or treatment (usually involving 
an overnight stay) that would not have been appropriate in the physician's office 
or an out-patient setting. Complications that occur during hospitalization are AEs. 
If a complication prolongs hospitalization or fulfills any other serious criteria, the 
event is serious. When in doubt as to whether “hospitalization” occurred, the 
event should be considered serious. 
• 
Results in persistent or significant disability/incapacity. Disability is defined as a 
substantial disruption of a person’s ability to conduct normal life functions. 
NOTE: The term disability means a substantial disruption of a person’s ability to 
conduct normal life functions. This definition is not intended to include 
experiences of relatively minor medical significance such as uncomplicated 
headache, nausea, vomiting, diarrhea, influenza, or accidental trauma (e.g., 
sprained ankle) which may interfere or prevent everyday life functions but do not 
constitute a substantial disruption. 
• 
Is an important medical event. An important medical event is an event that may not 
result in death, be life-threatening, or require hospitalization but may be considered 
an SAE when, based upon appropriate medical judgment, it may jeopardize the 
subject and may require medical or surgical intervention to prevent one of the 
outcomes listed in the definitions for SAEs. Examples of such medical events include 
allergic bronchospasm requiring intensive treatment in an emergency room or at 
home, blood dyscrasias or convulsions that do not result in subject hospitalization, or 
the development of drug dependency or drug abuse. 

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All available information on a serious adverse event(s) and any other associated AE, 
if applicable, must be forwarded to the study coordinator for forwarding to the 
Medical Monitor immediately (i.e., within one working day of the Investigator’s or 
site’s knowledge of the event) as follows: 
o In studies utilizing EDC (electronic data capture), all available information for 
the SAE and any associated AE(s) must be entered immediately into the EDC 
system.  
o Additional information for any applicable event is to be reported as soon as it 
becomes available. 
 
In addition to the reporting of serious adverse events to the study Medical Monitor, the 
SAE must be reported to the IRB / IEC according to their requirements. 
 
The investigator must document all adverse device events (serious and nonserious but 
related) and all serious adverse events (related and unrelated) on the Adverse Device 
Effect and Serious Adverse Event Form. Any device quality complaints will also be 
documented.  
 
• Both the Quality Complaint Form and the Adverse Device Effect and Serious 
Adverse Event Form must be e-mailed immediately to the study coordinator 
(Ariel Alyea). 
• Additional relevant information is to be reported as soon as it becomes 
available.   
 
Study coordinator contact information is provided below. 
 
Table 13.3.-1:  
Contact Information for FS200 Study 
Study Staff 
Business Phone 
e-mail 
24-hour  
Office Phone 
Ariel Alyea 
701-222-2020 
ali@bismarcklasik.com 
701-204-3620 
 
Further, depending upon the nature of the adverse event (serious or nonserious) or quality 
complaint being reported, the study sponsor may request copies of applicable portions of 
the subject’s medical records.  The investigator must also report all adverse events and 
quality complaints according to the relevant IRB requirements. 
 
12.3.1 Intensity and Causality Assessments  
For every adverse event and quality complaint, the investigator must assess the 
causality as Related or Not Related to the medical device under investigation. An 

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assessment of causality will also be performed by the Medical Monitor utilizing 
the same definitions, as shown below: 
 
Causality 
Related 
An adverse event or quality complaint classified as related may be 
either definitely related or possibly related where a direct cause 
and effect relationship with the medical device has not been 
demonstrated, but there is a reasonable possibility that the adverse 
event or quality complaint was caused by the medical device. 
 
 
Not Related 
An adverse event or quality complaint classified as not related may 
either be definitely unrelated or simply unlikely to be related (i.e., 
there are other more likely causes for the adverse event or quality 
complaint). 
 
Where appropriate, the investigator must assess the intensity (severity) of the 
adverse event as mild, moderate, or severe based on medical judgment with 
consideration of any subjective symptom(s), as defined below:  
 
Intensity (Severity) 
Mild 
An adverse event is mild if the subject is aware of but can easily 
tolerate the sign or symptom. 
Moderate 
An adverse event is moderate if the sign or symptom results in 
discomfort significant enough to cause interference with the 
subject’s usual activities. 
Severe 
An adverse event is severe if the sign or symptom is incapacitating 
and results in the subject’s inability to work or engage in their 
usual activities. 
 
The investigator must document any action taken (i.e., medication, intervention, 
or treatment plan) and outcome of the adverse event or quality complaint when 
applicable. 
13.4. Follow-Up of Adverse Events and Quality Complaints 
The investigator is responsible for adequate and safe medical care of subjects during the 
study and for ensuring that appropriate medical care and relevant follow-up procedures 
are maintained after the study.  Any additional data from these follow-up procedures 
must be documented and available to the study coordinator who, with the Medical 
Monitor, will determine when the data need to be documented on the CRFs.  
13.5. Safety Analyses 
The type, severity, duration and frequency of reported ocular adverse events will be 
tabulated.  Adverse events will also be summarized for events that were considered 
treatment-related.   

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14. GCP, ICH and ETHICAL CONSIDERATIONS 
This study will be conducted in compliance with Good Clinical Practices (GCPs), 
including International Harmonization (ICH) Guidelines, and in general, consistent with 
the 1996 version of the Declaration of Helsinki.  In addition, all applicable local, state 
and federal requirements will be adhered to. 
 
This study is to be conducted in accordance with Institutional Review Board regulations.  
The investigator will obtain appropriate IRB/ethics committee approval prior to initiating 
the study. 
 
The study will be registered with clinicaltrials.gov. 
 
14.1 Confidentiality 
The data collected will be data typical for the procedure(s) when performed on eyes 
outside the study. Any data collected will become part of the patient’s clinical record. 
The data will be subject to the same privacy and confidentiality as other data in the 
clinical record. 
 
Only the principal investigator, research consultant and clinic staff will have access to the 
data collected. All data shared outside the practice will be de-identified; patients’ 
protected health information will not be available and will not be reported in any analyses 
or publications. No data will be sold to third parties. De-identified data may be used for 
future research.  

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15.  STANDARD EVALUATION PROCEDURES  
Table 15.1. Proposed Visits and Study Assessments 
                  (visits are by patient, with both eyes tested) 
 
 
Activity 
Pre-
operative 
Operative 
Visit 1 
Visit 2 
 
 
Informed Consent 
X 
 
Demographics 
X 
 
General Information:   
Medical History 
X 
 
Surgery 
 
X 
Manifest refraction 
X 
 
Monocular uncorrected distance VA 
X 
 
Monocular corrected distance VA 
X 
 
Pachymetry (Oculus Pentacam) 
X 
 
Horizontal White to White (Vario) 
X 
 
Pachymetry (WaveLight EX500) 
Before Flap Lift 
 
X 
Pachymetry (WaveLight EX500) 
After Flap Lift, Before Ablation 
 
X 
Measurement of flap diameter 
 
X 
Monitor for Adverse Events and 
Device Deficiencies 
 
X 
Complete Exit Form1 
 
X 
 
1 Complete Exit Form upon termination of subject participation, or at Visit 2, whichever 
occurs first. 
16. CONFIDENTIALITY 
No protected health information (PHI), including the patient’s name and date of birth, 
will be collected; to ensure this, no PHI information is permitted to be entered on any of 
the Case Report Forms (CRFs). Subjects will only be identified by subject IDs and 
identities will be removed at the initial visit so that there is no further need to protect or 
destroy the information. Collected information will only be used for purposes of this 
study and no information will be sold to third parties. The non-PHI information collected 
may be used for future research, though there is currently no plan to do so.  
17. FINANCIAL AND INSURANCE INFORMATION/STUDY RELATED 
INJURIES 
Every effort to prevent study-related injury will be taken by the Study Doctor and staff. 
In the event a patient is injured as a direct result of the study while following the Study 
Doctor’s instructions and the study requirements, the patient will be instructed to contact 
his or her doctor immediately. The Study Doctor is to treat the injured subject as needed 
for those injuries caused directly by this research study. In the event of injury or illness 

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caused by or occurring during a subject’s participation in this research study, all charges 
for medical care provided to the subject will be billed to his or her insurance company. 
The Study Doctor or Sponsor does not offer to cover the medical care costs for injuries or 
illnesses that are not caused directly by the research study. The Sponsor does not offer to 
provide any other compensation, unless specifically agreed to elsewhere in this 
document. This information will be provided to each study subject before the start of the 
study in the consent form. 
18. STUDY ENDPOINT CRITERIA 
18.1. Patient Completion of Study  
If a study patient has completed the final visit (Visit 3) of the study, he/she is considered 
to have completed the study.  
 18.2. Patient Discontinuation  
Each study patient may voluntarily discontinue the study at any time they choose.  Study 
patients who cannot complete the study for administrative reasons (e.g., non-compliance, 
failure to meet visit schedule, etc.) will be discontinued from the study.  Study patients 
discontinued during the enrollment phase (prior to surgery) of the study will be replaced.  
 18.3. Patient Termination  
A study patient will be terminated if the study patient develops any severe adverse event 
that may be related to the study.  A study patient will receive appropriate treatment at the 
discretion of the investigator.  Notification of termination will be clearly documented.  
These study patients are considered to have completed the study and will not be replaced.   
18.4. Study Termination 
The investigator with appropriate notification may terminate the study.  If, after clinical 
observations, the investigator feels that it may be unwise to continue the study, he may 
stop the study.   
18.5. Study Completion  
The study will be complete when all enrolled patients have completed Visit 3 or have 
been terminated from the study.   
19. SUMMARY OF RISKS AND BENEFITS 
19.1. Summary of risks 
The risks with this study are similar to those for any patient receiving bilateral LASIK.3 
There is no increased risk associated with the proposed study. 
19.2. Summary of benefits 
Previous studies have shown that the WaveLight® FS200 (Alcon, Fort Worth, Texas, 
USA) provides good visual outcomes for patients at distance.1,2 Patients who participate 
in the study will not receive reimbursement. 

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REFERENCES 
1. 
Cummings AB, Cummings BK, Kelly GE. Predictability of corneal flap thickness 
in laser in situ keratomileusis using a 200 kHz femtosecond laser. J Cataract 
Refract Surg. 2013;39(3):378-385. 
2. 
Kanellopoulos J, Asimellis G. Digital analysis of flap parameter accuracy and 
objective assessment of opaque bubble layer in femtosecond laser-assisted 
LASIK: a novel technique. Clinical Ophthalmology. 2013. 
3. 
Kim T-i, Alió del Barrio JL, Wilkins M, Cochener B, Ang M. Refractive surgery. 
The Lancet. 2019;393(10185):2085-2098.