COMPLEX PATIENTS, PLANNED TO SURGERY.
Fourteen demonstration reports on deliberately difficult, fictitious cases. Each one starts where most software stops — and ends with an approval-ready surgical plan: parameters, nomogram values, follow-up schedule and the reasoning next to every threshold.
Every patient in these files is invented. Each page carries a DEMO watermark and the note "fictitious patient — not for clinical use". What is real is the engine: layout, calculations, bands and wording are exactly what a surgeon receives on the line.
LASER ON A THIN CORNEA (Q-LASIK · ML7 + EX500)
A 500 µm cornea with −6.00 −1.25 D: the standard plan (110 µm flap, 6.5 mm zone) violates the stromal floor by 19 µm — most software stops there. The optimizer scans every flap × zone combination and finds the safe window: a 90 µm flap on the CLB −10 blade with a 6.0 mm zone passes every floor with margin. The report ends with the complete operative plan — ring, vacuum, hinge direction and thickness, ablation depth, expected post-op keratometry — plus the Rule 13 negative-proof reconstruction (a regular bow-tie concordant with the printed Kmax) and the verdict "this eye is operable".
ICL IN HIGH MYOPIA (EVO TORIC)
−12.00 D on a flat 41.0 D cornea: tissue passes, optics do not — the post-op K window closes the laser route. The patient is not rejected; the report plans the ICL operation: the ACD endothelium conversion, full candidacy, the verified input set ready for OCOS, target refraction, and a follow-up schedule that carries the borderline angle into every visit. Power and size are deliberately left to the surgeon.
PROGRESSIVE KERATOCONUS (SAME-SESSION RING + CXL)
A 19-year-old progressive cone with pathological indices: the corneal laser is contraindicated, but treatment planning begins exactly there. The report weighs CXL, ICRS, CAIRS and DALK against this eye, then writes the same-session plan — femtosecond tunnel at 75% depth, Keraring SI-6 on the steep meridian, accelerated epi-off CXL with the mandatory intraoperative pachymetry gate — and maps the second stage of visual rehabilitation.
POST-LASIK CATARACT (TRUE CORNEAL POWER)
Fifteen years after myopic LASIK, no refractive passport, a 2-dioptre SimK error waiting to happen: three independent corneal-power layers agree within 0.3 D, the formula set is replaced, the IOL class is decided with the post-LASIK trifocal caution — and the report now shows the oblate corneal profile as a three-panel 3-D reconstruction and separates the two failure mechanisms (refractive-index power error and Double-K ELP error) before ending with the operative plan: verified inputs, target, incision guidance and the renewed passport.
CONTACT-LENS WARPAGE (RULE 13 · WITH 3-D RECONSTRUCTION)
A first topography that looks like keratoconus — 5 of 9 warpage indicators positive — rendered as the report's standard three-panel 3-D surface reconstruction. Fifteen days of stabilisation later the map is CLEAR, pachymetry recovers 24 µm, and the report locks a full Q-LASIK plan to the stable scan.
WFG/TG VECTOR PLANNING (HIGH ORA · AMARIS 1050RS)
Manifest cylinder 2.38 D at the corneal plane, corneal cylinder 0.75 D: the full Alpins double-angle decomposition — X/Y components printed step by step — yields an ORA of 1.69 D @ 86°, so the cylinder lives in the lens, not the cornea; a low, regular bow-tie reconstruction proves it visually. Three treatment scenarios are compared as vectors, the 60/40 apportioned plan is chosen, and the SCHWIND AMARIS 1050RS plan respects the platform's own geometry: the transition zone is computed by CAM and grows with the correction. CI, DV and IOS await the outcome.
COMPLICATION ANALYSIS (THE 'BUTTONHOLE' THAT WASN'T)
An intraoperative 'buttonhole' reported on a linear-cutting keratome — which by kinematics cannot produce one. The mimicker table finds the real cause (excess anaesthetic loosening the epithelium), grades severity, writes the second-surgery route at 3 months and two permanent preventive actions. Internal, blameless, process-focused.
ENHANCEMENT (AN 8-YEAR-OLD FLAP)
Residual −0.75 D over an old flap: late re-lift carries ~9% ingrowth, so the surface route takes priority; the cumulative tissue budget — including cumulative PTA — passes, the recut prohibition stands, and the retreatment becomes a planned transepithelial PRK with MMC.
DRY EYE (PSEUDO-KERATOCONUS ON THE MAP)
A moderate-severe MGD candidate whose tear film paints a false cone on the topography. The differential separates pseudo from true, a three-week staged surface plan is written, and the procedure direction (nerve-sparing) is set for the re-evaluation — stabilise, then operate.
PRESBYOPIA (PRESBYOND, NOT FULL MONOVISION)
A 52-year-old emmetrope who drives at night: dominance strength, a 12-day contact-lens trial and a 6.4 mm scotopic pupil select a blended-vision profile over full monovision. Age-based targets, published tolerance figures as numbers, and a tissue budget that already reserves the reversal.
REFRACTIVE PASSPORT & IOL (THE PROMISE KEPT)
The counterpart of the post-LASIK cataract demo: this patient carries a passport. Barrett True-K History opens, two consistency audits validate twelve years of data, and 'the difficult eye' becomes a predictable operation — then the passport itself is renewed for the decades ahead.
OUTCOME REGISTRY (A PERSONAL NOMOGRAM IS BORN)
Thirty-two one-line follow-up records turn "my patients end up slightly plus" into +0.18 D with a ±0.11 D confidence interval — below the proposal gate derived from the surgeon's own distribution. A 3% spherical adjustment is proposed, never auto-applied, and the cylinder subgroup keeps filling its own gate.
PATIENT INFORMATION REPORT (PLAIN LANGUAGE)
A different kind of output: once the surgeon's decision is final, the engine writes a plain-language summary for the patient — the planned procedure, why they were found suitable, the rules to follow, the risks in honest words, the check-up schedule and the emergency signs. It offers no alternatives, states twice that it is not a consent form, and is always handed over by the surgeon as their own document.
GLAUCOMA SCREENING (TISSUE PASSES, THE LAYER SAYS WAIT)
A high-myopic LASIK candidate whose tissue budget and optical window are clean — RSB 343 µm, RCT 443 µm, PTA 37.1%, all green. Most software would sign here. The G1–G13 layer instead flags six findings: a narrow angle with family history, a borderline anterior chamber, pigment-dispersion signs, a disc haemorrhage that OCT cannot image, fourteen months of a preserved pressure drop, and a single unconfirmed IOP reading. The report shows every triggered rule with its band and source, the auto-produced Referral Summary, and both surgical routes held behind one precondition — never an exclusion.
WHAT THESE FILES DEMONSTRATE
- Complex is not inoperable — the engine searches the parameter space for the safe window instead of stopping at the first failed check
- Every report ends in a plan: concrete parameters, device nomogram values, follow-up schedule
- Every value carries its source; missing data is requested by name, never assumed normal
- The engine never rules a patient "inoperable" — findings concern the plan; the decision rests with the surgeon
FREQUENTLY ASKED QUESTIONS
RLES AI runs as a mobile interface on your phone — nothing to install from a store, reports in minutes. The final clinical decision always rests with the surgeon.
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