Topography-guided LASIK provides personalized vision

One of the most common questions I hear every day from patients is, “What is new in refractive surgery?” I have asked Jim Owen, OD, an expert in refractive surgery technology, to discuss the latest version of LASIK-topography-guided LASIK-with David Geffen, OD, FAAO, who participated in Alcon’s Contoura Vision clinical trials.

Dr. Owen: What is Contoura Vision? 

Dr. Geffen: Contoura Vision is the latest refractive system from Alcon that combines the Allegretto Wave Eye-Q 400 Hz or the Wavelight EX500 excimer laser with the Wavelight Topolyzer Vario to create a unique treatment plan for every patient.

The U.S. Food and Drug Administration (FDA) approved this system in 2013, and it became commercially available in November 2015. My surgeon partner Michael Gordon, MD, and I were fortunate to have participated in the FDA trial for Alcon. To date, we have treated over 500 eyes at our clinic with the Contoura Vision System.

Dr. Owen: Why is topography important, and how is it different from wavefront-guided procedures and wavefront-optimized procedures?

Dr. Geffen: The accuracy of the Vario topographer combined with the speed and precision of the Allegretto EX500 laser has made this procedure possible. It is the next evolution beyond wavefront-guided and/or wavefront-optimized procedures.

With wavefront-guided procedures, while we hoped to reduce the amount of higher-order aberrations, what we were really doing was reducing the increase in higher-order aberrations. 

This was a significant improvement over standard treatments, but not the super vision we had hoped. Additionally, wavefront-guided treatments can vary with age, accommodation, and pupil size. Wavefront-optimized treatments reduced the increase in spherical aberrations, which are aberrations that caused the most night vision symptoms; so it, too, was a great improvement over standard procedures.

The Contoura Vision system neutralizes all the aberrations on the cornea, which are the aberrations we should treat with refractive surgery. We are not treating any of the aberrations associated with the lens of the eye, which we all know change over the life of a patient.

Topography-guided treatments are accurate, reproducible, and independent of accommodation and pupil size.

For our referring doctors and during surgery, this procedure is exactly the same as our other LASIK procedures. It is in the preoperative planning that the customization takes place. The surgeon evaluates information from the Vario topographer, the manifest refraction, and the wavelight aberrometer to create a unique and customize treatment for each patient.

Dr. Owen: How do your results compare to other refractive procedures your clinic performs?

Dr. Geffen: The concept of topography-driven LASIK has been around for awhile, and in Europe surgeons have used topography driven treatments to “fix” irregular corneas. Obviously, there are only a small number of patients who would benefit, and those results have been fair at best. For the U.S. FDA trial, we treated only virgin eyes, and we really did not know what to expect. In the end, the results were incredible.

Contoura has produced the best results of any laser we have used or any study in which we have participated. The FDA results found nearly 69 percent of patients achieved uncorrected vision of 20/16 or better.¹

Additionally, at 12 months, slightly over 31 percent of patients gained one line of uncorrected vision over their previous best corrected vision.¹ The number of patients who have improved vision is remarkable.

In the study, one eye was randomized to be treated with Contoura and the fellow eye with Wavefront Optimized on the same laser platform. We found the Contoura eyes out performed the Wavefront Optimized eyes in every metric-they saw better, had better contrast sensitivity, and the patients had greater patient satisfaction.¹

Our clinic has participated in many studies, and this is the first time patients could tell the difference in vision between the two treatments.

Dr. Owen: Who are candidates for this procedure?

Dr. Geffen: Currently, the procedure is approved only for myopes, but we hope to see approvals for hyperopes and irregular corneas in the future. While any myope up to -9.00 D sphere and -3.00 D cylinder is a candidate, we have found those patients with a higher amount of higher-order aberrations (above 30 µm RMS) and those patients greater than -4.00 D sphere and -2.00 D cylinder achieve the greatest benefit.

Dr. Gordon has experience with every type of laser that has been approved in the U.S., and he simply tells patients, “This is the best technology I have ever used and is the technology that will get you the best vision.”

This technology has gotten both our surgeon and staff enthusiastic about laser vision correction. While we charge a premium for the procedure, more than half of our patients elect to have the Contoura Vision procedure. Our referring doctors are also excited about the Contoura Vision procedures because they see very happy patients back after surgery. 

Reference

1. FDA Clinical Trials. Allegretto Wave Eye-Q Addendum Procedure Manual T-CAT Topography-Guided Treatments. http://www.accessdata.fda.gov/cdrh_docs/pdf2/P020050S012d.pdf.