Cataract Surgery Corneal Repair Utilizing the CREATE Protocol

Cataract Surgery is the most performed surgical procedure in the United States and has a phenomenal track record for improving vision. The most common surgical approach creates surgical incisions in the peripheral cornea. However, in rare cases, the incisions function as astigmatic keratotomy (AK or RK) incisions and induce irregular astigmatism. This side effect usually leads to a patient that measures well on an eye chart but is unhappy with their vision.
We treat this irregularity very similarly to an RK repair. The irregularity in the cornea, including the part being compensated for by the epithelium, is treated and decreased.

The treatment is in two phases. Phase 1 treats the corneal irregularity and makes a more uniform cornea. Included in this repair is the significant portion of the irregularity masked by epithelial compensation, which topography-guided ablation (market name Contoura) cannot measure.

This laser procedure, the CREATE Protocol, has been granted a patent by the U.S. Patent Office to Dr. Motwani (European Patents Pending). Phase 2, which typically occurs four months later, corrects the cornea’s power and results in a full correction.

In the interim healing period, patients can wear glasses or contacts to treat the refractive error, but with significantly decreased visual symptoms as the cornea is a much more ideal shape.

In treatment post cataract, usually, the first phase allows us to get close enough that the refractive error treated in Phase 2 is not large. Most patients do not use glasses for distance but may use some for reading while awaiting phase 2.

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