ONLINE EXCLUSIVE
Refractive
Spring 2025
by Ellen Stodola
Editorial Co-Director
Avi Wallerstein, MD, FRCSC, and Mathieu Gauvin, PhD, discussed mEYEstro, a new software they created to automate and standardize the reporting of refractive surgery outcomes. They shared why this is an area of need and the features of mEYEstro with EyeWorld.
As practicing ophthalmologists and researchers deeply involved in refractive procedures, we consistently review the latest scientific literature to stay abreast of advancements and outcomes in our field, Drs. Wallerstein and Gauvin said in an email to EyeWorld. “Over time, we noticed a recurring issue: Many published studies were not fully adhering to the standardized reporting guidelines recommended by leading journals and professional bodies. This lack of standardization made it challenging to compare results across different studies, hindering the collective ability to evaluate and advance surgical techniques,” they said. “Simultaneously, we recognized a significant gap in the available tools for analyzing refractive surgery outcomes.” They added that existing software solutions typically required cumbersome manual data entry, were time-consuming, and were prone to user error. In addition, they tended to lack comprehensive functionality, such as automated statistical analyses or the ability to generate comparative standardized graphs necessary for academic publication. Furthermore, they were often not free, which limited access for many practitioners.
Source: Avi Wallerstein, MD, FRCSC, and Mathieu Gauvin, PhD
“These limitations prompted us to conceptualize mEYEstro. Our vision was to create a free, user-friendly software that could automate and standardize the reporting of refractive surgery outcomes. We aimed to develop a tool that would simplify the process of generating high-quality graphs and performing rigorous statistical analyses, all while requiring minimal user input. By making advanced analytical capabilities accessible to all clinicians, surgeons, and researchers, we hoped to improve the quality of outcome reporting and facilitate better-informed clinical decisions,” Dr. Gauvin said.
“Our goal is also to enable practitioners worldwide to share and compare their results in a standardized, meaningful way,” Dr. Wallerstein added.
Prior to the development of mEYEstro, Drs. Wallerstein and Gauvin said their approach to analyzing refractive surgery outcomes involved a combination of manual methods and general purpose software tools. “We primarily used Microsoft Excel spreadsheets. For statistical analyses and graph generation, we often resorted to separated statistical software or even custom scripts. This process was inherently time consuming and demanded a considerable amount of manual effort to input data, set up formulas, and customize graphs,” they said. “Moreover, this manual approach was susceptible to human error at various stages, from data entry mistakes to incorrect statistical test applications.” Such errors could compromise the accuracy of the results, which is particularly concerning in a clinical context where precise data is crucial for patient care and for informing surgical adjustments.
mEYEstro represents a significant advancement. The software automates the process of outcome analysis. Users can input their data into a standardized Excel template, and mEYEstro handles the rest, they said, allowing anyone to perform precise statistical analyses and to generate high-resolution, standardized graphs in a matter of seconds. This automation eliminates the potential for manual errors and greatly reduces the time required to analyze data. “Furthermore, mEYEstro ensures that all outputs adhere to the standardized formats recommended by experts in the field. This adherence facilitates easier comparison between studies and compliance with academic publication standards.”
According to Dr. Gauvin, mEYEstro is designed for universal accessibility and requires no specialized equipment. The software guides users through an intuitive process that begins by selecting the type of refractive surgery performed. Users can also specify whether their analysis involves a single group, two unpaired groups (like two groups of different patients), or two paired groups (contralateral eye studies). The program then prompts users to customize group names and colors and to set specific parameters for the study’s outcomes. Once these settings are configured, users upload their dataset using the provided standardized Excel spreadsheet. mEYEstro processes the data and provides a file containing multiple high-resolution images of accurately graphed outcomes. The entire process is streamlined and efficient, Dr. Wallerstein said, typically taking less than a minute. “This makes advanced outcome analysis accessible to any ophthalmologist or researcher, regardless of their technical expertise.”
Drs. Wallerstein and Gauvin have been utilizing mEYEstro since its earliest development in 2017, 6 years before its release to the public. “It has become an integral component of our clinical and research activities,” they said. “This tool has significantly transformed our approach to outcome analysis in refractive surgery. Previously, comprehensive analysis was conducted less frequently due to the time and effort required. Now, with mEYEstro’s efficiency, we can perform detailed analyses on a much more regular basis. One of the most notable improvements we have observed is in our quality assurance processes. By using mEYEstro for consecutive sampling, we can continuously monitor our surgical outcomes to ensure they align with expected standards within and between our clinics. This ongoing evaluation allows us to detect subtle trends or shifts in performance that might indicate the need for adjustments in surgical technique, equipment calibration, or patient selection criteria.”
They added that the ability to quickly generate precise scattergrams for attempted versus achieved outcomes has been particularly valuable. These visual representations facilitate the creation and refinement of surgical nomograms, enabling them to adjust surgical parameters more accurately. “As a result, we’ve seen improvements in the predictability and accuracy of refractive outcomes, leading to higher patient satisfaction levels. We now use mEYEstro routinely, incorporating it into our workflow for both clinical assessments and research projects. For research purposes, mEYEstro has been indispensable in handling large datasets efficiently, enabling us to conduct robust studies and contribute meaningful findings to the field.”
Drs. Wallerstein and Gauvin said that data privacy and security are paramount considerations in any medical setting, and they have prioritized these aspects in the development of mEYEstro. “Recognizing the sensitivity of patient information, we designed the software to operate entirely as a standalone application on the user’s local computer. This means all data processing occurs locally, and there is no need to upload patient data to external servers or cloud-based services. By keeping all data operations confined to the user’s system, mEYEstro minimizes the risk of data breaches or unauthorized access,” they said, adding that the software does not ask for patient names or date of birth and does not transmit any information over the internet.
It can be used offline, which adds an extra layer of security, they said. Users have complete control over their data. The software itself does not store data anywhere. The graphs and outputs are saved locally in user-designated folders, allowing practitioners to manage and secure their data according to their institution’s policies and protocols. “mEYEstro is designed to be easily updated if needed so we will follow new trends as they emerge and if requested by our users,” they said.
The doctors received enthusiastic feedback from the reviewers of papers and from the global ophthalmology community since making mEYEstro freely available. “Practitioners from various countries and diverse settings have shared their experiences, and the responses have been overwhelmingly positive,” they said. “Many users appreciate how the software simplifies a complex and time-consuming task, allowing them to focus more on clinical insights rather than data preparation and complex statistical processing. Users have highlighted its user-friendly interface and the ability to generate comprehensive analyses and high-quality graphs within seconds. Researchers particularly value the standardized, high-resolution graphs and statistical summaries that adhere to academic publication standards. This feature streamlines the preparation of manuscripts and presentations, facilitating the dissemination of findings.” They added that mEYEstro has been cited in peer-reviewed publications and presented at professional conferences, indicating its adoption and utility in the field.
Since its initial release, Drs. Wallerstein and Gauvin said there have been ideas for enhancements to the tool. “We have been actively working on enhancements to expand its functionality and improve user experience. One of the significant improvements underway is the integration of advanced analyses for corneal crosslinking procedures,” they said. “Given the increasing prevalence of corneal crosslinking in managing conditions like keratoconus, we recognize the need for specialized analytical tools in this area. The upcoming update will enable practitioners to assess refractive outcomes specific to corneal crosslinking with greater standardization.”
Enhancing the nomogram features is another area of focus. By providing more sophisticated tools for nomogram creation and adjustment, mEYEstro will assist surgeons in fine tuning surgical parameters to improve predictability and patient outcomes, Dr. Gauvin said.
“In terms of accessibility, we are also developing a web-based version of mEYEstro,” Dr. Wallerstein added. “This online platform will allow users to access the software from any device with internet connectivity, offering greater flexibility without compromising data security since the data will never be stored. The web-based version will maintain the same privacy standards, ensuring that data processing remains secure and compliant with regulations.”
Looking ahead, Drs. Wallerstein and Gauvin said they are also exploring the development of additional tools to address other needs in ophthalmology. “For example, we’re working on TxFix, a tool designed to assist surgeons in the rare event of an incorrect excimer ablation. TxFix will enable immediate calculation of the expected refraction while the patient is still in the surgical suite, allowing for prompt corrective action,” they said. “We are committed to supporting the ophthalmology community and invite practitioners to contribute to the ongoing development of mEYEstro. User feedback is crucial in refining the software and ensuring it meets the evolving needs of the field. We encourage users to share their experiences, suggestions, and any challenges they encounter. We are excited about the future and look forward to working collaboratively with the community to realize the full potential of mEYEstro and design new software,” they said.
Relevant disclosures
Gauvin: None
Wallerstein: None
Contact
Gauvin: mgauvin@lasikmd.com
Wallerstein: awallerstein@lasikmd.com
