The use of WaveLight Contoura to create a uniform cornea: 6-month results with subjective patient surveys

Abstract

PurposeThe aim of this study was to report on the 6-month visual results of Contoura with Layer Yolked Reduction of Astigmatism (LYRA) protocol, as well as the subjective patient-reported outcomes (PRO) by standardized survey.Patients and methodsA retrospective analysis was conducted in 50 consecutive eyes with 6-month results that had bilateral Contoura laser-assisted in situ keratomileusis (LASIK) correction of measured astigmatism and axis using the LYRA protocol. PRO were measured via the Refractive Status and Vision Profile (RSVP) standardized survey. Objective visual results, subjective patient results, and rates of regression were reported.ResultsMost (78%) of the eyes achieved an uncorrected visual acuity (UCVA) of 20/15 and 98% of the eyes achieved an UCVA of 20/20 vision after primary correction. After enhancements, the percentage of uncorrected eyes achieving 20/15 vision was 90 and 20/20 vision was 100. RSVP patient-related outcomes showed that all patients (100%) were either satisfied or very satisfied with their vision. Most patients (21/25, 84%) were very satisfied. On a numerical ordinal scale of 1–10 (where 10 is the best vision), as reported by patients post-operative (post-op), 15 (60%) patients reported a vision score of 10, nine (36%) patients reported a score of 9, and one (4%) patient reported a score of 8. Initial correction was accurate on all patients, but nine eyes had refractive error changes due to epithelial masking of higher order aberrations (HOAs) over the follow-up period, a number that was also likely artificially high due to study bias.ConclusionContoura measured axis and astigmatism-eliminated HOA, resulting in a more uniform cornea with an accurate removal of astigmatism, excellent 20/15 and 20/20 visual outcomes, and favorable patient-reported subjective outcomes.

Quality of life in stable and progressive ‘early‐stage’ keratoconus patients

“…However, all these studies concentrated on more advanced stages/patients with a significant decrease in the CDVA. To cope with our setting of analysing KC patients with only minor CDVA impairments, we decided to add the ‘Refractive Status and Vision Profile’ (RSVP) – questionnaire which is established in analysing the vr‐QoL in humans with refractive errors (and usually a normal CDVA and/or minor higher order aberrations) (Gothwal et al 2010; Motwani & Pei 2018). Thereby, as recommended by Gothwal et al (2010), we only used the RSVP composite score and excluded the subscales from our analyses.…”

“…To analyse the vision‐related quality of life (vr‐Qol) in our patients, two different questionnaires were used. Both were evaluated and used in former studies for either ‘measuring Vision‐related Quality of Life in Persons with Refractive Error’ (The Refractive Status and Vision Profile; RSVP) (Gothwal et al 2010; Motwani & Pei 2018) or analysing the ‘Vision‐Related Quality of Life in Patients with Keratoconus’ (National Eye Institute Visual Functioning Questionnaire – 25; NEI‐25) (Kymes et al 2004; Aydin Kurna et al 2014; Mahdaviazad et al 2018; Kanellopoulos 2019). For both, the scores from the questionnaires were measured on a scale from 0 to 100, where 100 determines the optimum level of QoL in relation to vision.…”

<p>Topography-Guided Refractive Astigmatism Outcomes: Predictions Comparing Three Different Programming Methods</p>

“…In 2016, Motwani reported 78% of eyes with 20/15 vision 3 months after initial treatment with the Contoura laser using the LYRA (Layer Yolked Reduction of Astigmatism) Protocol, which is based on the Topo cylinder with spherical adjustment to maintain the spherical equivalent of the manifest refraction 4,9,10 This protocol also produced excellent Refractive Status and Vision Profile subjective patient survey outcomes. 11 Also in 2016, Kanellopoulos used the Topo cylinder modified to preserve the spherical equivalent of the manifest refraction to obtain 20/16 or better in 50% of eyes, compared to 22% of eyes in which manifest refraction was used to program the laser. 12 In a more recent study, Wallerstein et al programmed the laser with the magnitude of the manifest cylinder and the Topo axis.…”

Treatment of Keratoconus with WaveLight Contoura and Corneal Cross-Linking Combined

“…7 In the United States, we now have US Food and Drug Administration (FDA) approval of both topographic guided ablation (WaveLight Contoura, WaveLight Laser Technologie AG, Erlangen, Germany) and corneal crosslinking. [8][9][10] In this study, we combine the two procedures utilizing the Athens Protocol, with some modifications from The San Diego Protocol for repairing and reconstructing corneas to perform keratoconus correction. 11 The goals of the procedure, in order of importance, are:…”