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

PURPOSE: This 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 METHODS: A 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. RESULTS: Average 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. CONCLUSION: This pilot study demonstrated that more uniform corneas can be created while treating hyperopic corrections, but a high level of secondary corrections were needed.