Comparison of Wavefront-Optimized Ablation and Topography-Guided Contoura Ablation With LYRA Protocol in LASIK

Abstract

PURPOSE: To compare the refractive outcomes and aberration data analysis of wavefront-optimized (WFO) ablation and topography-guided Contoura ablation (TGCA) (Contoura on the WaveLight laser; WaveLight GmbH, Erlangen, Germany) in patients who had laser-assisted in situ keratomileusis (LASIK) for myopia or myopic astigmatism. METHODS: In this comparative contralateral eye study, patients who underwent LASIK with TGCA in one eye and with WFO ablation in the fellow eye were analyzed. Aberration measurements and corneal topography were analyzed using the WaveLight Oculyzer II diagnostic device (Alcon Laboratories, Inc., Fort Worth, TX). Total corneal higher order aberrations (HOAs) including vertical and oblique astigmatism (Z 2 2 , Z 2 −2 ), coma (Z 3 1 , Z 3 −1 ), trefoil (Z 3 3 , Z 3 −3 ), spherical aberration, and Q value were analyzed. These measurements were taken preoperatively and 3 months postoperatively. RESULTS: This study comprised 32 patients. There were no significant differences between both procedures according to postoperative uncorrected and corrected distance visual acuity values, refractive errors, and manifest refraction spherical equivalents within ±0.50 diopters (D) of emmetropia ( P > .05). The preoperative corneal HOAs and Q values were also similar between the groups ( P > .05). At 3 months postoperatively, the vertical and horizontal coma values in the WFO ablation group were statistically significantly higher compared to the TGCA group ( P = .013 and .020, respectively). Less stromal tissue was ablated in the TGCA group compared to the WFO ablation group ( P < .001). CONCLUSIONS: Although WFO ablation and TGCA protocols had statistically similar visual outcomes, the TGCA protocol was associated with a significantly lower induction in vertical and horizontal coma and smaller amount of tissue ablation compared to WFO ablation. [ J Refract Surg. 2019;35(4):222–229.]

<p>Clinical Outcomes After Topography-Guided Refractive Surgery in Eyes with Myopia and Astigmatism – Comparing Results with New Planning Software to Those Obtained Using the Manifest Refraction</p>

“…Visual acuity and residual refractive cylinder data using PAE are better than those reported for topography-guided ablations in some previous large studies using the same laser but using the manifest refraction to plan the ablation profile, while the Manifest results here appear similar or slightly better than those previously reported with the use of the manifest refraction as the treatment input in the same studies; note that inclusion and exclusion criteria may vary between studies. 5,10 The PAE results are also superior to those reported in the trial conducted for FDA approval of the Contoura procedure, 4 despite the fact that the PAE group eyes were not limited by consideration of the difference between the preoperative corneal and refractive astigmatism values. They also appear better than the results achieved using the topographic cylinder and axis, 6 or some combination of the topographic and manifest cylinder axis.…”

Femtosecond laser-assisted in situ keratomileusis with topography-guided or asphericity-adjusted derived data: a comparative contralateral eye study

“…Kim et al [ 25 ] found that the visual and refractive results were similar in contralateral eyes in the T-CAT and WFO groups; however, significantly fewer HOAs were induced with T-CAT. Ozulken et al [ 26 ] found excellent results using T-CAT over WFO in 32 patients, with less induction of horizontal and vertical coma-type aberrations, a smaller amount of ablated tissue and 20/20 UDVA in 97% of patients. On the other hand, Zhang et al [ 27 ] reported unfavourable results using topography-guided surgery in 432 virgin eyes of 216 patients, with less accuracy in corrected astigmatism than WFO despite demonstrating less induction of high-order aberrations.…”

Femtosecond Laser-Assisted in Situ Keratomileusis with Topography-Guided or Asphericity-Adjusted Derived Data: A Comparative Contralateral Eye Study

“…Furthermore, the results of topography-guided surgery were worse when the displacement of the astigmatism axis ranged from 21 to 45°. Ozulken et al [27] To the best of our knowledge, this is the rst prospective, randomized, double-blind comparative study comparing Contoura and Custom-Q ablation treatments in normal contralateral eyes. The importance of these results is reinforced by two factors.…”