Many patients wonder “is refractive surgery safe?” and the answer is ues. Refractive surgery has a unique history of adaption and success.
For the first time ever, we can create eyes with the potential to be better than the ones we were born with. For hundreds of years, we have corrected refractive error such as nearsightedness, farsightedness, and astigmatism with glasses, then contact lenses.
Now, for the last 20 years, we have used laser vision correction for this purpose. The refractive surgery community has become very good at it, and laser technology has become so sophisticated that our results are excellent, peaking with the use of WaveLight EX500 and the WFO protocol.
However, we have always dreamed of the ability to make corneas “better than normal” and to perform corrections that were superior to those made by glasses, soft contact lenses, or corrections made by conventional laser systems.
This Wavelight Contoura system requires the use of the 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. The cornea is the front clear bubble of the eye that does the majority of focusing of light of the eye. It is responsible for focusing images onto the nerve layer of the retina, which then sends this information to the brain.
Any abnormality of the cornea will prevent a sharp, clear image from being focused on the retina, causing blurring of the image. The information from the Topolyzer is sent to the WaveNet server, which analyzes the cornea, and then sends the information to the EX500 laser to direct treatment.
It also sends information using the pupil and the iris, ensuring that the laser aligns to the eye for correction in the same way that it did on the Topolyzer analyzer.
The Contoura 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 GmbH — 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 focuses light on the retina, the nerve layer that transmits 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 this focusing system and proved it with data to show that it worked. The LYRA Protocol has produced tangible results by significantly decreasing corneal flaws and distortions. Additionally, the light scatter caused by halos and night glare has been reduced, which in turn likely decreases the brain processing power necessary to ignore these visual distortions.
The LYRA Protocol is different from normal Contoura. The results of our study show that 80.85% of participants (50 eyes between -8.00 diopters of myopia and -3.00 diopters of astigmatism) achieved vision of 20/15 or better by 3 months postoperatively. In fact, over 60% of patients had already achieved 20/15 vision after 1 month.
In the FDA study, only achieved 65% 20/15, and these were still the best results ever seen in 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 and night glare. Many patients noted within days that the 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, weren’t sure what to reply 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 secondary procedures being necessary. Dr. Motwani followed a group of patients with very high levels of nearsightedness and the resulting corneal smoothness is striking compared to the results of any preceding laser system. These results will be submitted for publication in 2017.
The WaveLight Contoura topography-guided laser system is the most technologically advanced laser vision correction system in the United States. 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 vision results, even after 3 months.
Pre-Op and Post-Op Topographies of eyes after Contoura laser correction:
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