Retrospective Study Comparing Topography-Guided and Wavefront-Optimized LASIK Procedures in a Single Center.

Purpose: To compare visual outcomes of eyes that had laser refractive surgery with the Contoura Phorcides treatment plan and eyes that had laser refractive surgery with the wavefront-optimized treatment plan using the same laser. Methods: Retrospective chart review of clinical outcomes of eyes that had either Contoura with Phorcides (CP) or wavefront-optimized (WFO) corneal refractive procedures using the Wavelight EX500 (Alcon Vision, LLC). Data were collected and compared for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, change in postoperative UDVA compared to preoperative CDVA, and change in postoperative CDVA compared to preoperative CDVA. Results: Total eyes included were 348, with 227 in the CP Group and 121 in the WFO Group. Post-operatively, there was a significantly higher percentage of eyes in the CP Group that were 20/16 or better compared to the WFO Group (57%, 129 eyes, and 17%, 21 eyes, respectively; p < 0.001). The percentage of eyes that gained 1 or more Snellen lines of UDVA compared to preoperative CDVA was higher in the CP Group (47%; 107 eyes) compared to the WFO Group (12%; 14 eyes), which was statistically significant (p < 0.001). Differences in refraction were statistically significant. Conclusion: Topography-guided and wavefront-optimized treatment profiles both provided excellent refractive results. A higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a wavefront-optimized treatment plan.

Laser in situ keratomileusis (LASIK) is a common procedure performed to reshape the cornea (transparent part of the eye) and provide clear, spectacle-free vision. There are many different technologies available for surgeons to choose a treatment plan. One of the most popular is called wavefront-optimized LASIK (WFO), which takes into account the curvature of the cornea. Recently, topography-guided LASIK treatment plans that incorporate a proprietary planning software (Contoura Phorcides) have been available that can factor in the individualized surface elevation characteristics of the cornea. The purpose of this study was to compare visual outcomes in patients that had LASIK with the Contoura Phorcides treatment plan to patients that had LASIK with the WFO treatment plan. The results of this study suggest that both treatment profiles both provided excellent refractive results. In addition, a higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a WFO treatment plan.

Topography-Guided LASIK: A Prospective Study Evaluating Patient-Reported Outcomes.

Purpose: To evaluate patient-reported outcomes with a validated patient questionnaire following topography-guided LASIK (TG-LASIK). Methods: Patients undergoing TG-LASIK using Phorcides analytic software were prospectively enrolled to receive an adapted Patient-Reported Outcomes with LASIK Symptoms and Satisfaction (PROWL) questionnaire before and 26-weeks after treatment. The main study outcome was the change in the Global Vision Satisfaction Index from the PROWL questionnaire. Results: Forty-six patients underwent treatment and completed the modified PROWL questionnaire before and 26-weeks after TG-LASIK. The Global Vision Satisfaction Index from the modified PROWL questionnaire improved from 4.07 (3.87-4.26) to 5.00 (4.81-5.19) after the TG-LASIK treatment (p < 0.0001). The study population's binocular uncorrected distance visual acuity was 20/16, 20/12.5, and 20/10 or better in 100%, 87.0%, and 15.2% at 26 weeks post TG-LASIK, respectively. Conclusion: Patient satisfaction as assessed with the modified PROWL questionnaire is very high after undergoing TG-LASIK using Phorcides analytic software. Patient-reported outcomes add another dimension when assessing treatment efficacy beyond change in visual acuity and corneal architecture, and specialists may consider incorporating such assessments into the consenting process and patient education at large.

Comparative analysis of outcomes following topography-guided laser in situ keratomileusis using manifest refraction versus a new topographic analysis algorithm.

Purpose: To compare the visual outcomes following topography-guided laser in situ keratomileusis (LASIK) treatment using manifest refraction versus a new topography analysis software. Methods: A prospective, randomized, observer-masked contralateral study was conducted in the refractive services of a tertiary eye care hospital in South India. Analysis of visual outcomes, corneal higher-order aberrations, and contrast sensitivity were performed at 3 months postoperative visit following uneventful topography-guided LASIK using the Wavelight EX500. One eye was treated with the Contoura platform using manifest refraction (Contoura), while the contralateral eye was treated using an ablation profile planned by the Phorcides Analytic Engine (Phorcides). Results: Sixty eyes of 30 patients were included in the study. At 3 months postoperative visit, the uncorrected distance visual acuity (UDVA) in the Contoura and Phorcides groups was logarithm of the minimal angle of resolution (logMAR) 0.04 ± 0.07 and logMAR 0.06 ± 0.1, respectively (P = 0.483). Postoperative manifest refractive spherical error (MRSE) was 0.12 ± 0.22 and - 0.06 ± 0.20 D in the Contoura and Phorcides groups, respectively (P = 0.338). Although higher number of eyes demonstrated a gain in one or more lines of corrected distance visual acuity (CDVA) in the Contoura group (16.6% vs. 6.6%), the difference was not statistically significant (P = 0.361). Vector analysis (Alpins criteria) for postoperative cylinder, contrast sensitivity measurement, and corneal higher-order aberration profile showed no significant difference between the two groups at 3 months postoperative visit (P = 0.213, 0.514, and 0.332, respectively). Conclusion: Quantitative and qualitative visual outcomes with the Phorcides Analytic Software were similar to the Contoura treatment using manifest refraction.

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.

PURPOSE: To compare clinical outcomes from topography-guided laser refractive surgery based on new planning software to outcomes based on using the manifest refraction. DESIGN: Single site, two-arm, retrospective chart review. METHODS: Clinical outcomes at a single site after topography-guided LASIK using the Wavelight excimer laser were evaluated, with a target postoperative follow-up time of 90 days. Eligible eyes were those that received on-label topography-guided treatment of myopia or myopic astigmatism with correction based on either the manifest refraction or results from the Phorcides Analytical Engine (PAE). Measures analyzed included the uncorrected (UDVA) and best-corrected (CDVA) distance visual acuity, the magnitude of refractive cylinder after surgery, the refractive error and changes from preoperative CDVA. RESULTS: The study included 115 eyes in the PAE group and 133 eyes in the Manifest group. Significantly more eyes in the PAE group had a CDVA of 20/15 or better (p = 0.05) and a UDVA of 20/15 or better (p = 0.05). Significantly more eyes in the Manifest group had a UDVA of 20/25 or worse (13/133 vs 1/115 in the PAE group, p = 0.002). There were significantly more eyes in the PAE group with no postoperative refractive cylinder (90% vs 77% in the Manifest group, p = 0.004). No eye in either group had a postoperative CDVA a line or worse than their preoperative CDVA. Three eyes in the Manifest group and no PAE eyes have had subsequent enhancement surgery. CONCLUSION: Mean results for postoperative refractive astigmatism, CDVA and UDVA were similar between the groups, but the clinical outcomes for the PAE group appeared less variable, with more eyes having no refractive astigmatism and a higher percentage of eyes having 20/15 or better CDVA and UCVA. The objective nature of the PAE is an advantage.

Predictions of Residual Astigmatism from Surgical Planning for Topographic-Guided LASIK Based on Anterior Corneal Astigmatism (LYRA Protocol) vs the Phorcides Analytic Engine.

PURPOSE: To identify the laser programming strategy that achieves the highest refractive astigmatism outcomes accuracy between LYRA surgical planning and Phorcides surgical planning. METHODS: One hundred one eyes successfully treated with Contoura with LYRA Protocol were retrospectively surgically planned with Phorcides to determine its accuracy. Eighteen eyes that had inaccurate 3 month outcomes with LYRA were also retrospectively planned with Phorcides. Two patients with one eye treated with LYRA and one with Phorcides surgical planning were analyzed for outcomes. RESULTS: Retrospective Phorcides surgical planning deviated from already successful treatments with LYRA Protocol 51% of the time, with an average astigmatic deviation of 0.69 diopters (D) and an average deviation of 7.1 degrees. The percentage of eyes of the 101 successfully treated with LYRA Protocol then planned with Phorcides differed by 0.5D in 19.8%, by 0.75D in 23.8%, and by 1D in 7.9%. A retrospective analysis with Phorcides of patients treated with LYRA Protocol with residual post-operative astigmatism demonstrated that Phorcides would have increased accuracy in only 33% of patients, and not helped or decreased accuracy in the rest. CONCLUSION: Phorcides was significantly less accurate in surgical planning than the LYRA Protocol overall and a 51% of primary patients could have a likelihood of significant residual astigmatism. Phorcides would also have provided a less accurate outcome in the majority of patients that needed secondary enhancement.