Updated on 

May 6, 2022

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

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.

There are three types of custom LASIK:

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

Custom LASIK procedures typically produce better results than standard LASIK.

However, due to advanced technology, they usually have a higher price tag.

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

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 higher-order aberrations can deliver better visual clarity than correcting lower-order aberrations alone.

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

Lower-order aberrations make up 90 percent of all aberrations in your eye. Higher-order aberrations make up about 10 percent.

Types of Custom 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, this custom LASIK technology is the most advanced form available in the United States.

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

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

Questions about LASIK? Call NVISION to speak with an experienced Patient Counselor who can answer all your questions and set up a free consultation. No commitment required.

LASIK Surgeon Using Laser

Contoura Vision Procedure

All LASIK surgeries involve the cornea, which is the clear covering on the front of the eye.

Conventional LASIK eye surgery corrects vision by taking your prescription and the overall shape of your cornea into account. Contoura topography-guided LASIK is much more detailed.

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

Overall, the procedure and recovery process for Contoura Vision LASIK is very similar to conventional LASIK.

The main difference is that the surgeon needs to take more pre-operative measurements into account.

The person does not experience any differences during the surgery.

Contoura Vision Cost

Since the technology is more sophisticated, topography-guided LASIK often costs more than conventional LASIK. 

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

If your quoted price is significantly lower, chances are you will receive a conventional LASIK procedure instead of a customized or bladeless surgery.

Ask your surgeon which option is best for you.

Pros & Cons

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 Contoura Vision causes less glare, light sensitivity, and difficulty seeing at night versus other LASIK procedures.

Removes less tissue

Because the procedure is more precise than conventional LASIK, the laser does not need to remove as much corneal tissue. People with thinner corneas might be a better candidate for topography-guided versus conventional LASIK.

Suitable for people with astigmatism

People with astigmatism often have irregularly shaped corneas. Contoura topography-guided 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 PRK (photorefractive keratectomy), RK (radial keratotomy), or Contoura Vision.

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

Limited treatment range

Diopters (D) are the units 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, or 9.0 D of myopia and astigmatism combined.

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

Contoura Topography-Guided LASIK for Abnormal Corneas

Though Contoura topography-guided LASIK is only approved in the U.S. to correct normal, untreated corneas, 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 been successful in using topography-guided technology to treat the conditions above.

In the U.S., some surgeons are adapting this technique as an off-label use. 

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

In patients with keratoconus, LASIK surgeons are performing topography-guided PRK along with a procedure called corneal cross-linking. When combined, these procedures help stabilize the cornea and reduce irregularities.

After surgery, many patients have enhanced visual acuity and quality of vision. In the future, the use of Contoura topography-guided technology on abnormal corneas may become widely available in the United States.

Wavefront-Guided

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

Conventional LASIK primarily treats your refractive error, which you can think of as the numbers on your eyeglass prescription.

Wavefront-guided technology corrects refractive errors along with higher-order aberrations.

What is a wavefront?

If you imagine multiple rays of light, the wavefront is a surface perpendicular to corresponding points on each of these light rays. 

Wavefront-Guided LASIK Procedure Overview

Before LASIK, your eye surgeon will use an instrument called a wavefront aberrometer 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, but may contain higher-order aberrations.

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, which includes any aberrations. 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 while minimizing any existing 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 & Cons

Wavefront-guided LASIK is excellent technology that many patients are eligible for. However, there are some drawbacks to consider.

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

A common concern with conventional LASIK is that patients with larger pupils may experience more night vision problems.

The symptoms include:

  • Halos
  • Glare
  • Reduced contrast sensitivity

Studies find that with wavefront-guided technology, pupil size does not have a significant impact on these side effects.

Suitable for subtle visual distortions

For patients who have existing higher-order aberrations before LASIK, wavefront-guided technology is an excellent option.

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 then pick up aberrations in the lens as opposed to the cornea.

This is not ideal for a wavefront-guided LASIK procedure since the goal is to correct irregularities 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 high-quality measurement on someone with a corneal scar or who has lens implants from cataract surgery.

If the aberrometer cannot take accurate readings, this error can cause more higher-order aberrations.

May leave less possibility for touch-ups

Since the procedure adjusts for corneal irregularities, you may have thinner corneas after surgery than with conventional LASIK.

This means a lower potential for a second LASIK procedure in the future.

Limited treatment range

Diopters (D) are the units used to measure your eyeglass prescription. Wavefront-guided technology is approved to treat about 7.0 D of myopia, 3.0 D of astigmatism, and 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.

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

Wavefront-Optimized

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

One concern with conventional LASIK surgery is that some patients experience light-related distortions after surgery. These side effects occur because the laser flattens your cornea, which is the clear covering in front of your eye.

These distortions are the higher-order aberrations discussed earlier.

Wavefront-optimized surgery prevents higher-order aberrations better than conventional LASIK.

This means clearer vision, particularly at night. 

Wavefront-Optimized LASIK Procedure

Before surgery, your eye doctor will check your prescription, which is called a subjective refraction. You may be familiar with this part of the eye exam when you must choose which lens looks clearer. 

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

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, which minimizes any postoperative higher-order aberrations.

Conventional LASIK flattens your cornea, which can cause glare, halos, and difficulty seeing at night. 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, wavefront-optimized procedures may cost less than more advanced types of LASIK, such as wavefront-guided or topography-guided LASIK.

LASIK typically ranges between $4,000 to $5,000 for both eyes. A conventional, non-bladeless LASIK procedure may cost less.

Pros & Cons

Pros of Wavefront-Optimized LASIK

Higher-quality vision

Wavefront-optimized LASIK gives you sharper vision versus conventional LASIK. Because wavefront-optimized procedures create fewer higher-order aberrations, patients experience less night vision problems.

Wide range of treatment

Wavefront-optimized LASIK is approved to treat up to 12.0 D of myopia, 6.0 D of astigmatism, and 6.0 D of hyperopia. This range is wider than other custom LASIK treatments.

A great alternative to other customized LASIK treatments

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

Unreliable measurements can happen for a variety of reasons, including eyelid interference, poor eye alignment, or 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 mainly prevents higher-order aberrations that occur during the procedure but does not treat pre-existing aberrations. 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 any residual prescription.

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

Wavefront-Guided vs. Wavefront-Optimized

Though the names are similar, wavefront-guided and wavefront-optimized are two different LASIK procedures. Wavefront-guided technology is more sophisticated and customized.

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

However, wavefront-optimized surgery uses advanced computer software to deliver a better visual outcome compared to conventional LASIK. 

Here are some important points to know about wavefront-guided and wavefront-optimized LASIK:

Wavefront-guided and wavefront-optimized LASIK both use advanced software. This helps to minimize post-surgical aberrations.

Studies find most people have minimal amounts of higher-order aberrations, especially at a younger age. These people would do well with either a wavefront-guided or wavefront-optimized procedure.

If a person does have pre-existing higher-order aberrations, wavefront-guided LASIK is the better option. 

You can think of wavefront-guided LASIK as minimizing pre- and post-surgical aberrations, while wavefront-optimized LASIK mainly prevents post-surgical aberrations.

Wavefront-optimized procedures are faster than wavefront-optimized LASIK.

Overall, research shows both wavefront-guided and wavefront-optimized LASIK deliver excellent visual outcomes.

However, wavefront-guided LASIK generally yields better vision results, with fewer aberrations post-surgically.

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

Surgeon performing LASIK Procedure
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, vol. 42, no. 4, 2011, pp. 314–320., doi:10.3928/15428877-20110421-01.
  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, 1 Oct. 2016, www.sciencedirect.com/science/article/pii/S088633501630325X.
  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, vol. 30, no. 2, Feb. 2014, pp. 88–93., doi:10.3928/1081597x-20140120-03.
  4. Kent, Christopher. “Topo-Guided Ablation & Irregular Astigmatism.” Review of Ophthalmology, 6 July 2017, www.reviewofophthalmology.com/article/topoguided-ablation-and-irregular-astigmatism.  
  5. Kent, Christopher. “Topo-Guided LASIK in Refractive Practice.” Review of Ophthalmology, 5 Feb. 2019, www.reviewofophthalmology.com/article/topoguided-lasik-in-refractive-practice.  
  6. Ozulken, Kemal, et al. “Comparison of Wavefront-Optimized Ablation and Topography-Guided Contoura Ablation With LYRA Protocol in LASIK. Journal of Refractive Surgery, vol. 35, no. 4, 1 Apr. 2019, pp. 222–229., doi:10.3928/1081597x-20190304-02.
  7. Machat, Jeffery J. “Evolution of the Wavefront-Guided Laser.” Cataract & Refractive Surgery Today, May 2015, www.crstoday.com/articles/2015-may/evolution-of-the-wavefront-guided-laser/.
  8. McCabe, Cathleen M. “PRK Versus LASIK After Cataract Surgery.” Cataract & Refractive Surgery Today, July 2016, www.crstoday.com/articles/2016-jul/prk-versus-lasik-after-cataract-surgery/.
  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, vol. 33, no. 6, 1 June 2017, pp. 362–368, doi:10.3928/1081597x-20161221-02. 
  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, vol. 36, no. 3, Mar. 2010, pp. 437–441., doi:10.1016/j.jcrs.2009.09.031.
  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, vol. 207, 4 June 2019, pp. 175–183, doi:10.1016/j.ajo.2019.05.026.
  12. Stephenson, Michelle. “Wavefront-Guided VS. Wavefront-Optimized Laser Treatments.” EyeWorld Online, ASCRS Ophthalmic Services, 30 June 2017, www.eyeworld.org/wavefront-guided-vs-wavefront-optimized-laser-treatments.
  13. Chan, Annie, and Edward E. Manche. “Effect of Preoperative Pupil Size on Quality of Vision after Wavefront-Guided LASIK. Ophthalmology, vol. 118, no. 4, Apr. 2011, pp. 736–741., doi:10.1016/j.ophtha.2010.07.030.
  14. Machat, Jeffery J. “Evolution of the Wavefront-Guided Laser.” Cataract & Refractive Surgery Today, May 2015, www.crstoday.com/articles/2015-may/evolution-of-the-wavefront-guided-laser/.
  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, vol. 33, no. 6, 1 June 2017, pp. 362–368, doi:10.3928/1081597x-20161221-02. 
  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, vol. 207, 4 June 2019, pp. 175–183, doi:10.1016/j.ajo.2019.05.026.
Melody Huang is an optometrist and freelance health writer. Through her writing, Dr. Huang enjoys educating patients on how to lead healthier and happier lives. She also has an interest in Eastern medicine practices and learning about integrative medicine. When she’s not working, Dr. Huang loves reviewing new skin care products, trying interesting food recipes, or hanging with her adopted cats.
Michael is the content strategist and a lead content writer for Vision Center. With eight years of experience in the world of content strategy and creation, Michael specializes in medical copywriting and advanced research methodologies.
https://www.visioncenter.org/author/michael/
Author: Michael Bayba  | UPDATED May 6, 2022
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Medical reviewer: Dr. Melody Huang, O.D.
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Dr. Melody Huang, O.D.
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The information provided on VisionCenter.org should not be used in place of actual information provided by a doctor or a specialist.

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