This was a retrospective analysis of the first 50 primary LASIK corrections of 26 patients performed by one surgeon (MM) at one center using Contoura measured astigmatism and axis (as per the Layer Yolked Reduction of Astigmatism [LYRA] Protocol) within the FDA indications of myopia up to −8.00D with astigmatism no >−3.00D. We included eyes with a myopic goal for monovision. We monitored all eyes for at least 3 months post LASIK via visual acuity, refraction, and Topolyzer Vario HOAs to determine if the eye was accurately treated and the LYRA Protocol was successful.
All surgeries were performed by one surgeon (MM) at one center in San Diego, CA, USA, using a WaveLight® EX500 with Contoura (WaveLight) and the Topolyzer Vario (WaveLight). All LASIK flaps were made with the Moria M2 Microkeratome (Moria Surgical, Antony, France) with 110 micron calibrated blades from Microspecialties, LLC, Middletown, CT, USA. All surgical planning was done using the Wavenet Server and the Contoura planning system using the LYRA Protocol, which is described below.
The measured Contoura astigmatism and axis were obtained from the surgical planning page in the Contoura planning software. This page is after the Topolyzer images are processed, and after the information is entered for the patient’s manifest refraction, pachymetry, and pupil size. On this page, the surgeon can enter their final input for sphere, astigmatism, and axis, and the effect on the ablation pattern will be shown as the values change. Zeroing out the sphere and astigmatism correction shows only the HOA removal, and the HOA pattern can be resolved. Entering the astigmatism and axis will create a pattern that can be compared with the anterior elevation of a Pentacam Scheimflug analyzer scan (Oculus, Wetzlar, Germany) (a Ziemer Gallelei [Ziemer Ophthalmic Systems, Port, Switzerland] will output similar scans). This demonstrates that using the measured Contoura astigmatism and axis creates an ablation pattern that closely matches the elimination of the anterior elevation on Pentacam, which results in a more uniform cornea.
This study included 50 eyes from 26 patients of which 10 were male and 16 were female. Patients’ ages ranged from 19 to 62 years, with an average age of 31.65 years. Preoperative evaluation included best corrected visual acuity, manifest/cycloplegic manifest refraction, anterior exam, posterior dilated exam, tonometry, pachymetry via Pentacam, autorefraction with the Nidek OPD (Nidek Co., Ltd, Gamagori, Japan), and topographic analysis with the Topolyzer Vario.
Specific attention was paid to obtaining high quality reproducible scans with the Topolyzer Vario. A patient would have 8–12 scans taken per eye, and at least 4 accurate similar scans with appropriate iris registration and complete data (as indicated by the Topolyzer Vario) were necessary to proceed with surgical planning. If the scans were too variable, or not enough scans with high quality information were taken, the scans were repeated until enough scans to create an accurate, reproducible, consistent picture were obtained. Great care was taken not to induce astigmatism when holding the eyelids open for scans, and blinks were allowed to prevent the corneal surface from desiccation.
Patients were not included if they had prior refractive surgery, could not achieve 20/20 vision preoperatively, were not within the FDA treatment parameters, had anterior segment abnormalities or findings that could affect the outcome such as keratoconus or corneal ectasia, recurring eye disease such as iritis or herpetic keratitis, severe dry eye, uncontrolled diabetes or hypertension, or were pregnant.
All patients provided written consent to have their data published in this paper.
All surgeries were performed by one surgeon (MM) at one center in San Diego, CA, USA, using a WaveLight® EX500 with Contoura (WaveLight) and the Topolyzer Vario (WaveLight). All LASIK flaps were made with the Moria M2 Microkeratome (Moria Surgical, Antony, France) with 110 micron calibrated blades from Microspecialties, LLC, Middletown, CT, USA. All surgical planning was done using the Wavenet Server and the Contoura planning system using the LYRA Protocol, which is described below.
The measured Contoura astigmatism and axis were obtained from the surgical planning page in the Contoura planning software. This page is after the Topolyzer images are processed, and after the information is entered for the patient’s manifest refraction, pachymetry, and pupil size. On this page, the surgeon can enter their final input for sphere, astigmatism, and axis, and the effect on the ablation pattern will be shown as the values change. Zeroing out the sphere and astigmatism correction shows only the HOA removal, and the HOA pattern can be resolved. Entering the astigmatism and axis will create a pattern that can be compared with the anterior elevation of a Pentacam Scheimflug analyzer scan (Oculus, Wetzlar, Germany) (a Ziemer Gallelei [Ziemer Ophthalmic Systems, Port, Switzerland] will output similar scans). This demonstrates that using the measured Contoura astigmatism and axis creates an ablation pattern that closely matches the elimination of the anterior elevation on Pentacam, which results in a more uniform cornea.
This study included 50 eyes from 26 patients of which 10 were male and 16 were female. Patients’ ages ranged from 19 to 62 years, with an average age of 31.65 years. Preoperative evaluation included best corrected visual acuity, manifest/cycloplegic manifest refraction, anterior exam, posterior dilated exam, tonometry, pachymetry via Pentacam, autorefraction with the Nidek OPD (Nidek Co., Ltd, Gamagori, Japan), and topographic analysis with the Topolyzer Vario.
Specific attention was paid to obtaining high quality reproducible scans with the Topolyzer Vario. A patient would have 8–12 scans taken per eye, and at least 4 accurate similar scans with appropriate iris registration and complete data (as indicated by the Topolyzer Vario) were necessary to proceed with surgical planning. If the scans were too variable, or not enough scans with high quality information were taken, the scans were repeated until enough scans to create an accurate, reproducible, consistent picture were obtained. Great care was taken not to induce astigmatism when holding the eyelids open for scans, and blinks were allowed to prevent the corneal surface from desiccation.
Patients were not included if they had prior refractive surgery, could not achieve 20/20 vision preoperatively, were not within the FDA treatment parameters, had anterior segment abnormalities or findings that could affect the outcome such as keratoconus or corneal ectasia, recurring eye disease such as iritis or herpetic keratitis, severe dry eye, uncontrolled diabetes or hypertension, or were pregnant.
All patients provided written consent to have their data published in this paper.
