Contoura Vision (Topography-Guided LASIK)

What is Contoura Vision (Topography-Guided LASIK)?

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.

Contoura Vision Procedure

All LASIK surgeries involve the cornea, which is the clear covering on the front of the patient's eye. Conventional LASIK eye surgery corrects your 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. Then 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. 

lasik eye surgery steps

What Are Aberrations?

Lower-order aberrations include myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. Most people notice blurry vision if they have uncorrected lower-order aberrations. Conventional LASIK surgery can treat these conditions. 

In contrast, higher-order aberrations are more difficult to treat with conventional LASIK. Higher-order aberrations are light-related distortions in your vision.

Symptoms of aberrations include:

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

Contoura vision correction surgery can minimize irregularities in the cornea, which results in fewer higher-order aberrations. 

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. Though there is more planning on the surgeon’s part, the patient does not experience any differences during the surgery itself.

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Contoura Vision Cost

Since the technology is more sophisticated, topography-guided LASIK often costs more than conventional LASIK. If your surgeon combines Contoura Vision treatment with a bladeless LASIK procedure, this may add to the cost as well. 

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 and Cons of Contoura Laser Eye Surgery

Contoura Vision Advantages

  • Higher-quality vision. As mentioned above, 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. Since the procedure is more precise than conventional LASIK, the laser does not need to remove as much corneal tissue. Patients with thinner corneas might be a better candidate for topography-guided versus conventional LASIK.
  • Suitable for patients with astigmatism. Patients with astigmatism often have irregularly shaped corneas. Contoura topography-guided LASIK may deliver better results for these patients than conventional LASIK.

Contoura Vision Disadvantages

  • 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. These are corneal diseases that cause abnormal corneal thinning (ectasia).
  • Post-surgical complications. Patients with a history of refractive surgery such as LASIK, PRK, or RK may develop irregularities in their corneas, including irregular astigmatism. 
  • Corneal scars. Scarring can also cause corneal irregularities.
  • Penetrating or lamellar keratoplasty. These are different types of corneal transplant procedures. After surgery, some patients experience significant amounts of irregular astigmatism.

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. 

Additionally, these 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.

Author: Melody Huang, O.D. | UPDATED April 21, 2020

Resources

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.

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.

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.

Kent, Christopher. “Topo-Guided Ablation & Irregular Astigmatism.” Review of Ophthalmology, 6 July 2017, www.reviewofophthalmology.com/article/topoguided-ablation-and-irregular-astigmatism.  

Kent, Christopher. “Topo-Guided LASIK in Refractive Practice.” Review of Ophthalmology, 5 Feb. 2019, www.reviewofophthalmology.com/article/topoguided-lasik-in-refractive-practice.  

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.

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