Custom Lasik (Wavefront-Optimized, Wavefront-Guided, Topography-Guided)

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If you're considering LASIK, you may wonder how new procedures like Contoura® Vision differ from standard LASIK. This article answers all your questions about custom LASIK procedures like Contoura. It also compares Contoura to other custom LASIK options and standard LASIK.

Thinking about LASIK? Start a conversation with an experienced Patient Counselor to find out if laser eye surgery is right for you. Learn More

What is Custom LASIK?

Custom LASIK is an advanced version of LASIK vision correction surgery. It uses cutting-edge technology to map and evaluate the unique features of your eye.

Custom LASIK procedures typically produce better results than standard LASIK. However, due to advanced technology, they usually have a higher price tag.

Types of Custom LASIK

There are three types of custom LASIK:

  • Topography-guided LASIK (Contoura® Vision)
  • Wavefront-guided LASIK
  • Wavefront-optimized LASIK

Topography-Guided (Contoura® Vision)

Contoura® Vision is a topography-guided LASIK surgery. It is an FDA-approved and customized laser vision correction surgery.

Currently, Contoura LASIK technology is the most advanced available in the U.S.

Contoura Vision eye surgery can deliver higher quality vision than conventional LASIK.

Topography-guided LASIK was FDA-approved in 2013 and became widely available in 2015.

What to Expect from a Contoura Vision LASIK Procedure

The procedure and recovery process for Contoura Vision is similar to conventional LASIK. The main difference is that the surgeon needs to take more pre-operative measurements into account.

First, your surgeon uses an instrument called a topographer. The topographer takes thousands of measurements across your entire cornea.These measurements provide a detailed map that includes any irregularities on your cornea’s surface. 

corneal topography

Contoura Vision Cost

Contoura LASIK often costs more than conventional LASIK. This is because the topography-guided technology is more sophisticated.

An average range for LASIK is $4,000 to $5,000 for both eyes.

If your quoted price is much lower, chances are you will receive a conventional LASIK procedure. Customized or bladeless surgery is typically more expensive. Ask your surgeon which option is best for you.

Pros of Contoura Laser Eye Surgery

Higher Quality Vision

Contoura Vision minimizes distortions in your vision. LASIK patients experience sharper vision after surgery, often better than with glasses or contacts. 

Fewer Side Effects

Studies show that Contoura Vision causes fewer side effects than other LASIK procedures. Side effects may include:

  • Light sensitivity
  • Glare
  • Difficulty seeing at night

Removes Less Tissue

Because Contoura is so precise, the laser doesn't need to remove as much corneal tissue. People with thinner corneas might benefit from topography-guided versus conventional LASIK.

Suitable For People With Astigmatism

People with astigmatism often have irregularly shaped corneas. Contoura LASIK may deliver better results for these people than conventional LASIK.

Cons of Contoura Laser Eye Surgery

Not Approved For Touch-Ups

Contoura Vision is not FDA approved to treat patients who previously had other refractive surgery, such as:

If you need a second procedure, your surgeon will recommend a different type of refractive laser surgery. Surgeons in other countries may use Contoura LASIK on patients who have had refractive surgery in the past.

Limited Treatment Range

Diopters (D) are used to measure your eyeglass prescription. Contoura topography-guided LASIK is FDA approved to treat:

  • Up to 8.0 D of myopia
  • Up to 3.0 D of astigmatism
  • 9.0 D of myopia and astigmatism combined

The majority of patients fall into this prescription range and can receive topography-guided treatment. Alternatives are available for patients with hyperopia or higher prescriptions. In these cases, wavefront-optimized LASIK may be an option.

Contoura Topography-Guided LASIK for Abnormal Corneas

Contoura topography-guided LASIK is only approved in the U.S. to correct normal, untreated corneas. However, surgeons are finding other uses for topography-guided technology.

Topography-guided technology is useful for corneal conditions such as:

  • Keratoconus and pellucid marginal degeneration
  • Post-surgical complications
  • Corneal scars
  • Penetrating or lamellar keratoplasty

Internationally, many LASIK surgeons have successfully treated these conditions with Contoura. In the U.S., some surgeons are adapting this technique for off-label use. 

Some surgeons use topography-guided PRK instead of Contoura LASIK to treat these corneal conditions. Many surgeons believe PRK is safer for patients with irregular corneas since no corneal flap is involved. 

Topography-guided PRK may be used with a corneal cross-linking procedure for patients with keratoconus. When combined, these procedures help stabilize the cornea and reduce irregularities. After surgery, many patients have enhanced visual acuity and quality of vision. 

LASIK Surgeon Using Laser

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Wavefront-Guided LASIK

When someone says "custom LASIK" they are usually referring to wavefront-guided LASIK.

Conventional LASIK primarily treats your refractive error. You can think of this as the numbers on your eyeglass prescription.

Wavefront-guided technology corrects refractive errors along with higher-order aberrations, such as glare.

What to Expect from Wavefront-Guided LASIK

Before LASIK, your eye surgeon will use an instrument called a wavefront aberrometer. They use this to take measurements of your eye. 

First, the wavefront aberrometer sends a beam of light through your eye. The light travels through your cornea and lens. These structures in your eye are naturally clear and help focus light.

The light reflects off your retina, which is the tissue lining the back of your eye. Then, the aberrometer measures the reflected wavefront as it travels back to the front of your eye.

The wavefront aberrometer uses this information to generate a 3D wavefront map. The map includes any aberrations, which are light-related vision distortions. A wavefront map is as unique as your fingerprint.

Wavefront Aberrometry

Your eye surgeon uses this map to customize your LASIK treatment. Wavefront-guided LASIK will correct your vision and reduce any higher-order aberrations in your corneas.  

The wavefront-guided LASIK procedure may take slightly longer than a conventional LASIK surgery. The recovery time is similar.

How Much Does Wavefront-Guided LASIK Cost?

Wavefront-guided LASIK usually costs more than conventional LASIK. An average range for LASIK is $4,000 to $5,000 for both eyes. A conventional, non-bladeless LASIK procedure may cost less. 

Pros of Wavefront-Guided LASIK

Higher Quality Vision

Wavefront-guided LASIK minimizes higher-order aberrations. It gives patients sharper vision compared to conventional LASIK.

Suitable For Larger Pupils

Night vision problems in patients with larger pupils is a common concern with standard LASIK.

The symptoms include:

  • Halos
  • Glare
  • Reduced contrast sensitivity

Studies find that with wavefront-guided technology, pupil size doesn't increase the risk for these side effects.

Suitable For Subtle Visual Distortions

Wavefront-guided technology is an excellent option for patients with higher-order aberrations. Symptoms of higher-order aberrations include:

  • Glare
  • Halos or starbursts
  • Shadows 
  • Difficulty seeing at night

These patients may have subtle corneal irregularities that glasses or contacts cannot correct.

Cons of Wavefront-Guided LASIK

May Not Suit Older Patients

Your cornea and lens are clear structures in your eye that help focus light. As we age, the lens develops into a cataract.

The wavefront aberrometer may pick up aberrations in the lens instead of the cornea. This isn’t ideal for a wavefront-guided LASIK procedure since the goal is to correct problems in the cornea.

Requires Accurate Aberrometer Results

Since a wavefront-guided procedure requires exact measurements, not everyone is a candidate.

For example, the aberrometer may not capture a precise measurement on someone with a corneal scar. Lens implants from cataract surgery can also cause difficulty.

If the aberrometer cannot take accurate readings, it can cause problems instead of fixing them.

May Leave Less Possibility For Touch-Ups

You may have thinner corneas after wavefront-guided surgery than with conventional LASIK. This means less potential for a second LASIK procedure in the future.

Limited Treatment Range

Diopters (D) are used to measure your eyeglass prescription. Wavefront-guided technology is approved to treat about:

  • 7.0 D of myopia
  • 3.0 D of astigmatism
  • 3.0 D of hyperopia

The majority of patients fall into this prescription range and can receive wavefront-guided treatment. However, patients with higher prescriptions require an alternative form of LASIK, such as wavefront-optimized.

Wavefront-Optimized LASIK

Wavefront-optimized LASIK is similar to conventional LASIK but with some enhancements.

One concern with conventional LASIK is the light-related distortions that may occur after surgery. These side effects happen because the laser flattens your cornea.

Wavefront-optimized surgery prevents these side effects better than conventional LASIK. This means clearer vision, especially at night.

What to Expect From Wavefront-Optimized LASIK

Before surgery, your eye doctor will check your prescription. You may be familiar with this eye exam part; it's when you must choose which lens looks clearer. 

The laser will use your prescription as the basis for your treatment, just like conventional LASIK.

However, the laser also uses special wavefront software. The program directs the laser to treat not just the center but also the periphery of your cornea. This allows your cornea to maintain its natural shape. Maintaining the cornea's shape minimizes the risk of postoperative vision problems.

Conventional LASIK flattens your cornea, which can cause vision problems like glare and halos. Wavefront-optimized LASIK maintains the natural curve of your cornea, creating fewer side effects.

How Much Does Wavefront-Optimized LASIK Cost?

Wavefront-optimized LASIK may cost slightly more than traditional LASIK. However, they may cost less than more advanced types, such as wavefront-guided or topography-guided LASIK.

Pros of Wavefront-Optimized LASIK

Higher Quality Vision

Wavefront-optimized LASIK gives you sharper vision versus conventional LASIK. Additionally, patients experience fewer night vision problems.

Wide Range of Treatment

Wavefront-optimized LASIK is approved to treat a wider range of vision problems than other custom procedures. This includes:

  • Up to 12.0 D of myopia
  • 6.0 D of astigmatism
  • 6.0 D of hyperopia

A Great Alternative to Other Customized LASIK Treatments

With other customized procedures, obtaining reliable measurements is more complicated.

Unreliable measurements can happen for various reasons, including:

  • Eyelid interference
  • Poor eye alignment 
  • Dry eyes

In these situations, the surgeon may perform wavefront-optimized LASIK instead.

Cons of Wavefront-Optimized LASIK

Does Not Correct Pre-Existing Corneal Irregularities

Wavefront-optimized surgery prevents higher-order aberrations that occur during the procedure. However, it doesn't treat pre-existing vision distortions. If you have irregular corneas, wavefront-guided LASIK may be more suitable for you.

May Not Suit Post-Cataract Surgery Patients

Occasionally, patients who receive cataract surgery need LASIK to correct remaining vision problems.

Depending on the type of lens implant used, wavefront technology may not produce high-quality measurements. The surgeon may perform conventional LASIK in these cases.

NVISION Eye Centers offer custom LASIK, affordable pricing plans, and a lifetime guarantee. Learn More

Wavefront-Guided vs. Wavefront-Optimized

Though the names are similar, wavefront-guided and wavefront-optimized are two different LASIK procedures. They both use advanced software to reduce the risk of post-surgical problems. However, there are key differences.

Wavefront Optimized

You can think of wavefront-optimized as an improved conventional LASIK procedure. Just like standard LASIK, wavefront-optimized LASIK relies on your eyeglass prescription to correct your vision.

However, wavefront-optimized surgery delivers a better visual outcome than standard LASIK.

Wavefront Guided

Wavefront-guided technology is more sophisticated and customized. It generally yields better vision results, with fewer aberrations post-surgically. If a person has pre-existing higher-order aberrations, wavefront-guided LASIK is the better option.

Custom vs Standard LASIK (What's the Difference?)

The main difference between custom and standard LASIK procedures is the technology used. We'll cover the types of technology used in each custom LASIK procedure below.

For now, we'll discuss the two major advantages that custom LASIK procedures provide:

Increased Precision

Diopters are the unit of measurement used to determine your eyeglasses prescription. If you've ever had an eye exam, you're probably familiar with a phoropter or refractor.

This is the machine doctors use to place different lenses in front of your eyes.

Phoropter Refractor

Each "tick" on the dial represents .25 diopter. This is why prescriptions contain numbers like 1.75 and 2.00, but never 1.8.

Wavefront LASIK technology uses a computer to measure vision correction to the nearest .01 diopter.

This makes it 25 times more accurate than standard measurements performed by an optometrist.

Increased Personalization

An eyeglasses prescription measures your eye's ability to focus light as one unit.

A custom LASIK measurement creates hundreds of different points to gather data. This creates a unique map or "fingerprint" that details your eye's imperfections.

This fingerprint shows higher-order aberrations, as well as common refractive errors.

The excimer laser can then personalize your vision correction based on this data.

What are Aberrations?

Higher-order aberrations are light-related distortions in your vision. They can occur in your cornea, which is the clear covering in front of your eye.

Higher-order aberration symptoms include:

  • Halos or starbursts around lights
  • Glare
  • Ghosting or shadows in your vision
  • Poor contrast sensitivity
  • Difficulty seeing in low light conditions

In contrast, your refractive error is an example of a lower-order aberration.

Lower-order aberrations include:

Correcting lower-order aberrations improves vision. However, addressing high-order aberrations provides greater clarity. Lower-order aberrations make up 90 percent of all aberrations in your eye. Higher-order aberrations make up about 10 percent.

People who have higher-order aberrations may be good candidates for a wavefront-guided procedure.

Surgeon performing LASIK Procedure

Still not sure about LASIK? Talk with an experienced Patient Counselor at NVISION to find out if it's right for you.

Call 866-424-0296

16 Cited Research Articles
  1. El-Awady, Hatem E., et al. “Wavefront-Optimized Ablation Versus Topography-Guided Customized Ablation in Myopic LASIK: Comparative Study of Higher Order Aberrations.” Ophthalmic Surgery, Lasers, and Imaging, 2011.
  2. Jain, Arun Kumar, et al. “Outcomes of Topography-Guided versus Wavefront-Optimized Laser in Situ Keratomileusis for Myopia in Virgin Eyes.” Journal of Cataract & Refractive Surgery, 2016.
  3. Kanellopoulos, Anastasios J., and George Asimellis. “Keratoconus Management: Long-Term Stability of Topography-Guided Normalization Combined With High-Fluence CXL Stabilization (The Athens Protocol).” Journal of Refractive Surgery, 2014.
  4. Kent, Christopher. “Topo-Guided Ablation & Irregular Astigmatism.” Review of Ophthalmology, 2017.
  5. Kent, Christopher. “Topo-Guided LASIK in Refractive Practice.” Review of Ophthalmology, 2019.
  6. Ozulken, Kemal, et al. “Comparison of Wavefront-Optimized Ablation and Topography-Guided Contoura Ablation With LYRA Protocol in LASIK.” Journal of Refractive Surgery, 2019.
  7. Machat, Jeffery J. “Evolution of the Wavefront-Guided Laser.” Cataract & Refractive Surgery Today, 2015.
  8. McCabe, Cathleen M. “PRK Versus LASIK After Cataract Surgery.” Cataract & Refractive Surgery Today, 2016.
  9. Moshirfar, Majid, et al. “Meta-Analysis of the FDA Reports on Patient-Reported Outcomes Using the Three Latest Platforms for LASIK.” Journal of Refractive Surgery, 2017.
  10. Perez-Straziota, Claudia E., et al. “Visual Acuity and Higher-Order Aberrations with Wavefront-Guided and Wavefront-Optimized Laser in Situ Keratomileusis.” Journal of Cataract & Refractive Surgery, 2010.
  11. Roe, Joshua R., and Edward E. Manche. “Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided and Wavefront-Optimized Laser in Situ Keratomileusis.” American Journal of Ophthalmology, 2019.
  12. Stephenson, Michelle. “Wavefront-Guided VS. Wavefront-Optimized Laser Treatments.” EyeWorld Online, ASCRS Ophthalmic Services, 2017.
  13. Chan, Annie, and Edward E. Manche. “Effect of Preoperative Pupil Size on Quality of Vision after Wavefront-Guided LASIK.” Ophthalmology, 2011.
  14. Machat, Jeffery J. “Evolution of the Wavefront-Guided Laser.” Cataract & Refractive Surgery Today, 2015.
  15. Moshirfar, Majid, et al. “Meta-Analysis of the FDA Reports on Patient-Reported Outcomes Using the Three Latest Platforms for LASIK.” Journal of Refractive Surgery, 2017.
  16. Roe, Joshua R., and Edward E. Manche. “Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided and Wavefront-Optimized Laser in Situ Keratomileusis.” American Journal of Ophthalmology, 2019.
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