Topographic-guided treatment of hyperopic corrections with a combination of higher order aberration removal with WaveLight^® Contoura and wavefront-optimized hyperopic treatment

Abstract

PurposeThis pilot study was conducted to test the hypothesis that WaveLight® Contoura and wavefront-optimized (WFO) hyperopic treatment can be used together for hyperopia/hyperopic astigmatism to create more uniform corneas.Materials and methodsA retrospective analysis was conducted in 35 consecutive hyperopic/hyperopic astigmatism eyes of 22 patients treated via LASIK on the Wavelight® EX500. Higher order aberrations and astigmatism were removed using Contoura with the Layer Yolked Reduction of Astigmatism (LYRA) Protocol, and hyperopia was treated with WFO correction. All patients had 3 months of follow-up. Outcome measures were assessed by post-operative refraction, regression, and post-operative vision. Topographic analysis showed the degree of uniformity of the cornea achieved.ResultsAverage hyperopia treated was +2 diopters (D) (range +0.50 D to +7.25 D), with the average amount of astigmatism treated +1.05 D (range −0.25 D to −2.25 D). The average difference between the Contoura-measured and manifest magnitude of astigmatism was 0.674 D and the average axis difference was 5.65°. No eyes lost corrected distance visual acuity (CDVA), 22.8% of eyes gained CDVA. At 3 months, 18 (54%) eyes had regressed or not achieved their targeted goal, and the average spherical equivalent (SE) from the targeted goal was 0.973 D. Following primary procedure, 10 of these eyes had myopic SE, six had hyperopic SE, and two had SE of 0. Prior to surgery, 19 of 24 distance eyes were able to achieve 20/20 vision, and if secondary corrections are included 100% achieved 20/20 or better post-operative, and eight (42%) achieved 20/15 or better at 3 months post-operative. No eyes lost CDVA.ConclusionThis pilot study demonstrated that more uniform corneas can be created while treating hyperopic corrections, but a high level of secondary corrections were needed.

Femtosecond‑LASIK outcomes using the VisuMax®‑MEL® 80 platform for hyperopia and hyperopic astigmatism refractive surgery

“…The safety of the procedure in these reports was reported as good; the number of eyes that lost two lines of CDVA postoperatively being either zero (1,6,8,25,29) or ranging between 1.09 and 4.34% (1,20,27,28,30,32). The reports in the literature mention that the improvement of the ametropic error allowed the gain in CDVA of one line in 44.6% of cases (1,9) and of two lines in 3.7 to 22.8% of cases in various studies (1,8,28).…”

“…Although some excimer lasers have been approved for corrections up to +6.0 D ( 1 , 7 ) and current technology using models with wide ablation and high correction speed has greatly improved prognosis ( 1 , 8 ) [large diameter optical areas being more resistant to epithelial hyperplasia that is responsible for real regression ( 1 , 7 )], latent hyperopia is often the reason why refractive surgeons avoid approaching cases of hyperopia and hyperopic astigmatism or limit the surgeries to refractive errors below +3.0 D ( 1 , 8 ). Laser refractive treatment is difficult to choose because ablation of manifest refraction in hyperopia or hyperopic astigmatism may lead postoperatively to recurrence of a degree of hyperopia, falsely interpreted as regression of the laser procedure ( 1 , 6 , 7 ), while ablation of cycloplegic refraction may lead to myopic refraction in the immediate postoperative period, causing an unsatisfactory UDVA ( 1 ).…”

“…Table III shows the follow-up periods and the refractive reports of all of these studies either with high (1,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(25)(26)(27)(28)(29) and lower predictability and efficacy rates for high refractive errors (1,6,24,30). The safety of the procedure in these reports was reported as good; the number of eyes that lost two lines of CDVA postoperatively being either zero (1,6,8,25,29) or ranging between 1.09 and 4.34% (1,20,27,28,30,32). The reports in the literature mention that the improvement of the ametropic error allowed the gain in CDVA of one line in 44.6% of cases (1,9) and of two lines in 3.7 to 22.8% of cases in various studies (1,8,28).…”