High Myopia and Hyperopia Correction - Cornea Revolution

High Myopia and Hyperopia Correction

Technically, treating high myopia (-9 to -16 diopters of correction) or high hyperopia (+3 to +6 or more) is not a corneal repair, but it is a complex procedure that few surgeons undertake. Topographic-guided ablation significantly improved high myopia treatments by creating a more uniform cornea with a large optical zone, minimizing the aberrant optics that lead to poor night vision. In the past, this latter problem has been the main issue with treating high myopia with an excimer laser, and many surgeons place ICL lenses in the eye for high myopia correction. ICL lenses have a series of complications, such as the creation of cataracts and endothelial cell loss.

The latter can potentially cause serious corneal complications requiring a corneal transplant to resolve. More long-term data is needed to show whether or not ICL use will contribute to corneal failure long term. Any procedure that enters the globe of the eye, such as implantation of ICL, will also have a low rate of severe eye complications such as endophthalmitis (internal eye infection) and retinal issues.

Topographic guided ablation does not enter the eye globe, is performed within the cornea, and removes the biological flaws (higher order aberrations) in the cornea that scatter light. When treated with Wavelight Contoura topographic guided ablation and the LYRA Protocol, our patients rarely see a significant worsening of night vision, even with very high corrections.

Treatment of high hyperopia does not necessarily need to utilize the LYRA Protocol, as the reshaping of the cornea is different. For years, many surgeons would not correct hyperopia over a +3 or +4, as studies utilizing the older lasers with older ablation patterns in the early 2000s showed poor effectiveness. This trend continued even as newer lasers such as the WaveLight Allegretto 400 and EX500 were FDA-approved up to +6.00. Dr. Motwani understood that he could treat high hyperopia effectively, and the frustration with inertia in the refractive surgery field was instrumental in his entering the academic research world. Dr. Motwani published the first paper focused on the treatment of high hyperopia. He demonstrated that the outcomes were BETTER than those of published results of low hyperopia 15 years prior. Dr. Motwani’s research led to more surgeons treating high hyperopia patients.

As an interesting aside, Dr. Motwani has benefitted himself from these protocols, as he was a high myope (-9 and -10) who had his original laser surgery flaws repaired with the CREATE Protocol in 2020. He was so confident in the outcomes of his research that he applied his findings to his own treatment.









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