HIGH MYOPIA CORRECTION

Technically, the treatment of high myopia (-9 to -15 diopters of correction) is not a corneal repair, but it is a complex procedure that few surgeons undertake so we have decided to include. The treatment of high myopia in many ways is significantly improved by topographic guided ablation as a much more uniform cornea with a large optical zone is created, minimizing the aberrant optics that lead to poor night vision. This latter problem has been the main issue with treating high myopia with excimer laser in the past, and many surgeons place ICL lenses in the eye for high myopia correction. ICL lenses have a series of complications, such as creation of cataract and endothelial cell loss. This latter has the potential to cause serious corneal complications leading to corneal transplant in the long term, and not enough long term data exists 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 small rate of serious eye complications such as endophthalmitis (internal eye infection) and retinal issues.

The use of topographic guided ablation does not enter the globe of the eye, is performed in the cornea, and also removes the biological flaws (higher order aberrations) in the cornea that scatter light. Our experience has been that patients when fully treated with Wavelight Contoura topographic guided ablation utilizing the LYRA Protocol often have no significant worsening of night vision, and have no issues seeing at night even with very high corrections.

The protocol for these treatments has been created by Dr. Motwani, who himself had high myopia before laser correction.

CASE 1 – OD

53 year old female, OD Contoura + WFO Epi-K
Pre-OP Manifest: OD: -14.25-2.25X010 BCVA 20/40
Contoura Treatment: OD: -8.00-1.37X173
WFO Treatment: OD: -2.75 D/S OS: -3.75 D/S
1 year Post Op: OD Refraction: -1.50 D/S J2 and 20/25

CASE 1 – OS

53 year old female, OS Contoura + WFO Epi-K
Pre-OP Manifest; OS: -13.25-2.00X177 BCVA 20/25
Contoura Treatment; OS: -8.00-1.78X014
WFO Treatment; OS: -3.75 D/S
ESX PRK WFO OS; +0.00-0.75X012
1 year Post Op; OS Refraction: plano and 20/20

CASE 1

• This is a 53 y.o. female patient with high myopia, presbyopia, and amblyopia. She was corrected using Epi-Lasik to make an epithelial flap, and then with Contoura with LYRA Protocol. Residual myopia after Contoura was corrected consecutively utilizing WFO. A nomogram for decreasing spherical myopic correction was utilized to prevent overcorrection. Mitomycin-C was applied for 45 seconds.
• Patient needed a small enhancement of 0.75D of astigmatism on one eye, and ended up gaining lines of vision in both eyes, achieving 20/20 in the distance eye uncorrected which was a gain of a line in vision, and 20/25 best corrected vision in her monovision eye which was a gain of 2 lines of vision.

CASE 2 – OD

25 year old male, OD Contoura + WFO PRK
Pre-Op Manifest: OD: -9.50-1.50X180 BCVA 20/30
Contoura Treatment: OD: -7.33-3.00X179
WFO Treatment: OD: +0.00-1.75X179
3 month Post Op: OD Refraction: plano and 20/20

CASE 2 – OS

25 year old male, OS Contoura + WFO PRK
Pre-Op Manifest:OS; -10.25-1.50X005 BCVA 20/30
Contoura Treatment; OS: -7.50-2.91X004
WFO Treatment; OS: -1.00 D/S
3 month Post Op; OS Refraction: plano and 20/20

CASE 2

25 year old male with high myopia and high astigmatism who had corneas that were too small to properly perform Epi-LASIK on so PRK was performed. Both eyes were corrected utilizing Contoura with LYRA Protocol. Mitomycin-C was applied for 45 seconds. Note large difference in between manifest refraction and cycloplegic refraction showing how pupil size can effect the refraction in someone with irregular astigmatism.

Patient gained a line of best corrected vision in each eye and was 20/20 in both eyes with plano correction at 3 months.

CASE 3 – OD

22 year old female, OD Epi-K Contoura + WFO
Pre-Op Manifest: OD: -13.50-3.25X175 BCVA 20/40
Contoura Treatment: OD: -7.75-2.30X001
WFO Treatment: OD: -4.75 D/S
3 Month Post Op: OD Refraction: plano and 20/30

CASE 3 – OS

22 year old female, OS Epi-K Contoura + WFO
Pre-Op Manifest; OS: -15.50-3.75X015 BCVA 20/60
Contoura Treatment; OS: -7.50-2.87X007
WFO Treatment; OS: -6.00 D/S
3 Month Post Op; OS Refraction: plano and 20/30

CASE 3

• 22 y.o. female with extremely high myopic with significant astigmatism. Patient had a “stepped” correction with a 6.0 mm Contoura with LYRA protocol initial ablation, and residual myopia performed with WFO at 5.00mm. This was necessary to fully correct the eyes with the amount of tissue available while leaving a thick enough residual bed. The patient had 6mm dark pupils, but has no significant problem with night vision/glare/halos.
• The patient improved from a best corrected vision of 20/60 to 20/30 with each eye 3 months post-op and plano refraction. Not only did this double the quantity of best corrected vision, she could now legally pass a driving license eye test allowing her to drive.

CASE 4- OD

19 Year old Female, OD Lasik Contoura + WFO
Pre-Op Manifest; OD: -10.75-0.25X170 BCVA 20/20
Contoura Treatment; OD: -8.00-0.43X005
WFO Treatment: -1.75 D/S
9 Month Post Op: plano refraction and 20/15
OU vision: 20/15

CASE 4- OS

19 Year old Female, OS Lasik Contoura + WFO
Pre-Op Manifest; OS: -11.50-0.75X105 BCVA 20/20
Contoura Treatment; OS: -8.00-0.25X114
WFO Treatment; OS: -2.25 D/S
9 Month Post Op: plano and 20/15
OU vision: 20/15

CASE 4

• 19 year old high myopia, daughter of Case 1. Patient wore RGP lenses, left out for 2 weeks. Patient had LASIK performed with Contoura with LYRA Protocol followed by residual spherical correction with WFO.
• Pt was 20/15 OU at her one week post-op, and continued that way throughout her follow up. Last check was at 9 months, as she goes out of town for college. Patient had good night vision from one week on.

CASE 5- OD

32 year old male, Lasik OD Contoura
Pre-Op Manifest; OD: -10.00-3.25×171 BCVA 20/20
Contoura Treatment; OD: -7.50-3.00X176
WFO Treatment; OD: -1.75-0.25X176
9 Month Post Op; OD: plano and 20/15
OU Vision: 20/15

CASE 5- OS

32 year old male, Lasik OD Contoura
Pre-Op Manifest; OS: -8.75-3.00X007 BCVA 20/20
Contoura Treatment; OS: -7.50-3.00X007
Enhancement at 3 months: WFO Treatment; OS: -0.25-1.00X006
9 Month Post Op; OS: plano and 20/20
OU Vision: 20/15

CASE 5

• 32 year old male with high myopia and moderate to high astigmatism.
• Patient had LASIK performed with Contoura with LYRA Protocol followed by WFO treatment of residual refraction.
• Patient had enhancement at 3 months post-op only in the left eye correcting 1D of astigmatism
• Patient had results of 20/15 OD, and 20/20 OS. Patient had no issues with night vision.