Wavelight Contoura Topographic Guided Laser System using the LYRA Protocol. A Revolution in Vision Correction With the Potential of Supranormal Human Corneas
For the first time ever, we can create eyes with the potential to be better than normal human. For hundreds of years we have corrected nearsightedness, farsightedness, and astigmatism with glasses, then contact lenses. For 20 years, we have been correcting astigmatism, nearsightedness, and farsightedness with laser vision correction (LASIK, PRK, LASEK, Epi-LASI, custom LASIK, Wavefront Guided LASIK, Wavefront Optimized LASIK etc). The refractive surgery community became very good at it, and laser technology became so good that our results were excellent, peaking with the Wavelight EX500 using the WFO protocol.
What we always dreamed of, though, was the ability to corneas “better than normal,” to perform corrections that were better than what can be corrected via any other laser system, and could also be better than wearing glasses or soft contact lenses. The Contura system using the LYRA Protocol (which is an acronym for Layer Yolked Reduction of Astigmatism) developed by Dr. Motwani in conjunction with Sissimos Lemonis of Wavelight Lasers is a huge step in that direction- a revolution in laser vision correction. When the FDA approved Wavelight Contoura, surgeons still did not fully understand the information being given by this very powerful system. The FDA studies were done with an incomplete understanding of not only Contoura, but of how the optical system focused light on the retina, the nerve layer that transmitted the images to the brain for processing and to produce what we call vision. Dr. Motwani and Sissimos Lemonis developed a completely new theory of understanding the focusing system of the eye, and proved it with data to show that it worked. Using the Lyra Protocol demonstrated corneas with significantly decreased flaws and distortions, making a cornea much more uniform thereby decreasing light scatter (which causes halos and night glare), and therefore also likely decreasing the brain processing necessary to get rid of the distortions to result in what we call vision.
The LYRA Protocol is different from normal Contoura, and our results in our study show that the results are significantly better with 80.85% of our study group of 50 eyes between -8.00 diopters of myopia and -3.00 diopters of astigmatism achieved vision of 20/15 or better by 3 months post-operatively. Even at one month, over 60% of patients had already achieved 20/15 vision. As of this writing, this study has been submitted for publication. The FDA approval study only achieved 65% 20/15, and the results were still the best results ever from an FDA study for a laser vision correction system. The LYRA protocol finally harnesses the true power of Contoura, with an entirely new understanding of how the human cornea focuses light for vision.
Even more striking was the lack of halos/night glare. Many patients noted within days that that lights at nighttime had minimal to no glow around them. This is because removing the biological distortions in the cornea reduces light scatter and reduces glare. Some patients when questioned if they had halos, would reply that they weren’t sure because they didn’t know what a halo was!
The Contoura with LYRA Protocol system also shows a relatively low level of regression, with very few second procedures necessary. Dr. Motwani is currently following a group of patients with very high amounts of nearsightedness- -9.00 to -15.00 diopters of myopia- and the results are striking of how smooth their corneas look in comparison to any past laser system. Results of this will be submitted for publication in 2017.
The Wavelight Contura Topographic Guided laser system is the technologically most advanced laser vision correction system in the United States, and one that has resulted in the best ever LASIK results in any FDA study ever done for myopic and myopic astigmatism, with 65% of patients from -8.00 diopters of myopia with up to -3.00 diopters of astigmatism achieving 20/15 vision. The LYRA Protocol takes this system even further by linking the Aberration Correction Layer (removal of the biological flaws in the cornea) with the Refractive Correction Layer (correction of nearsightedness and astigmatism), and achieves over 80% 20/15 even after 3 months.
This system requires the Wavelight Topolyzer Vario analyzer, which takes the most detailed map ever done of the cornea using 22,000 points of information to analyze any abnormalities or aberrations of the cornea. The cornea is the front clear bubble of the eye which does the majority of focusing of light of the eye, and focuses images onto the nerve layer of the retina which sends it to the brain. Any abnormality of the cornea will prevent a sharp, clear image to be focused on the retina causing blurring of the image. This information from the Topolyzer is sent to the WaveNet server which analyzes the cornea, and then sends the information to the EX500 laser on how to correct it. It also sends information using the pupil and the iris allowing the laser to line up the eye for correction in the same way that it was on the Topolyzer analyzer.
In fact, the Contura system is able to get astigmatism that we have never been able to correct or treat before, making the cornea for many patients truly uniform, smooth, and clear for the first time in their lives. Many patients have never had their astigmatism corrected like this, because for the first time the astigmatism information is coming directly from the analyzer, and includes the effect of removal of the biological distortions. Biological distortions can affect the measurement of astigmatism in the now old-school manual way, as a person’s brain is trying to find the point of least confusion between the distortion of the astigmatism, and the distortion of the biological aberrations. Using Contoura with the LYRA Protocol is the only true way to find all of the corneal astigmatism. It turns out almost all patients have some corneal astigmatism, as very few people actually have perfectly round corneas.
The Contura system is able to detect, analyze, quantitate, and then correct these biologic abnormalities that make the cornea asymmetric and imperfect, making it far smoother and much more uniform. The laser then corrects the nearsightedness and astigmatism of the cornea as determined in the examination as the second part of the correction, and both of these parts of the correction are usually performed within 10-20 seconds of laser time.
This kind of correction has never been possible before, and we believe that in many patients it will be better than vision obtainable by glasses, contacts, and better than any other laser procedure or vision correction system except for RGP (“hard”) contact lenses. The goal is to create as smooth and perfectly shaped cornea as possible to allow for superior vision, high levels of better than 20/20 vision, decrease or elimination of night driving difficulties, decrease or elimination of glare, decrease or elimination of light sensitivity, and result in very high levels of patient satisfaction.
The Wavelight Contura system is able to eliminate asymmetries and aberrations in corneas that were never treatable by any past laser systems, making this in incredibly powerful tool. Therefore, it not only requires a very thorough diagnostic analysis pre-procedure, and requires a surgeon who truly understands and is capable of using the full extent of the powerful abilities of Wavelight Contura. Dr. Motwani has been on the leading edge of adoption of Contura, and was among the very first surgeons to use it after FDA approval in the United States. It is new LYRA Protocol that has changed the way all surgeons will use Contoura in future. Dr. Motwani is also among the few surgeons in the United States that uses the topographic guided system to repair warpage and distortion from past corneal surgery, trauma, or disease.
Wavefront Guided systems have been left far behind by topographic guided ablation, and no other laser company besides Visx is now actively further developing or actively promoting the usage of wavefront guided systems. A Visx Wavescan device only measures about 240 points on the cornea, and even the latest Visx iDesign only measures about a 1000. Again compare that with the accuracy of the Contura system which measures 22,000 points on the cornea, and is able to perform a true, detailed correction of the focusing system of the eye. Much like a higher resolution picture or television is clearer, the Contura system gives a far more detailed, intricate, and clearer map of the cornea down to even its smallest aberration and distortions. Furthermore, wavefront guided systems do not tell you where in the eye the flaws are, and are completely non-specific optical pathway. Therefore, you are truly not sure exactly what it is you are correcting and from what source.
The Wavelight Contura system has been FDA approved for even high levels of myopia and astigmatism, up to -8.00 diopters of nearsightedness, and -3.00 diopters of astigmatism. It is not yet approved for treatment of hyperopic corrections, but can be done as an off label procedure.
Pre-Op and Post-Op Topographies of eyes after Contoura laser correction:
Pre-Op Refraction: -5.50, -1.50 x 177
Pre-Op Refraction: -2.75
Pre-Op refraction: -5.50, -.050 x 5
Pre-Op Refraction: -6.50, -2.25 x 13
Pre-Op Refraction: -7.00, -0.50 x 23
Pre-Op Refraction: -7.25, -0.50 x 180
For those patients that cannot have (or do not want) a corneal flap, or have a thinner cornea, custom PRK can be performed. Several methods are used by Dr. Motwani to remove the epithelium including laser removal. Mitomycin-C is used to prevent haze. The use of oral ibuprofen and pain preventing eye drops has essentially eliminated the majority of discomfort post PRK, making it a much easier procedure for those who choose or need it. Healing time for the epithelium is usually 3-4 days, but during that time the patient may continue normal activities such as using a computer, watching TV, doing normal, light activities, going shopping, and even going to the movies. Driving during that time is not recommended. For those who need an advanced form of PRK, Epi-Lasik (E-LASIK) is also a procedure choice.
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