EyeWorld Asia-Pacific March 2016 Issue

March 2016 10 EWAP FEATURE Getting started with topography-guided ablations by Lauren Lipuma EyeWorld Contributing Writer As topography-guided LASIK enters the U.S. market, experienced surgeons share valuable knowledge they’ve gained about the technology A fter more than 15 years in international markets, topography- guided ablations are finally available to U.S. surgeons. Alcon (Fort Worth, Texas) is launching Contoura Vision, the first personalized topography- guided LASIK platform approved by the U.S. Food and Drug Administration. But this is not a simple plug-and-play technology. According to experts, refractive surgeons must be dedicated to spending the time to learn the nuances, capabilities, and limitations of this system in order to offer patients the best visual outcomes. Alcon began training a small subset of physicians on the topography-guided platform in December 2014. One of those physicians was Kerry Solomon, MD, Carolina Eyecare Physicians, Mt. Pleasant, SC. Corneal topography and ablation pro le for a patient undergoing topography-guided PRK showing areas of myopic and hyperopic ablation Source: Raymond Stein, MD, FRCSC AT A GLANCE • Topography-guided LASIK is approved for treating routine myopia with or without astigmatism. • Experts recommend starting out with normal eyes with fairly regular topography. • Operating on irregular corneas requires compensating for the refractive shift induced by neutralizing the corneal aberrations. “The whole concept of topo- guided ablations makes sense to me,” Dr. Solomon said. Although wavefront-guided treatments have been the gold standard and give patients excellent visual results, Dr. Solomon thinks that topo-guided treatments are better suited for patients who will eventually need cataract surgery or other procedures to treat their aging eyes. “A topo-guided treatment also treats higher order aberrations, but it normalizes the corneal surface, so if the prescription of the eye were to change over time, now we’re dealing with a more normal cornea and a more normal corneal shape,” he said. A. John Kanellopoulos, MD, medical director, LaserVision Eye Institute, Athens, Greece, and clinical professor, New York University Medical School, New York, has been using this technology in Europe over the last 14 years, has published dozens of peer reviewed articles on topography-guided ablations, and proctored the first group of physicians performing the procedure in the U.S. Dr. Kanellopoulos pointed out that topo-guided treatments center treatment on the corneal apex, rather than the center of the pupil, and this could be one reason the procedure has had such good outcomes, which were confirmed in the recent large multicenter FDA study of topo-guided treatments. “The outcomes [of the clinical trial] were, in my opinion, astounding, showing that topography-guided procedures had a much larger percentage of eyes gaining a line of vision— some gaining 2 lines of vision. I welcome the availability of this very effective technology for my patients in the U.S.,” Dr. Kanellopoulos said. “I think this corresponds with several European investigators, including myself, who for many years have advocated for topography- guided treatments being superior to standard treatments, purely based on the fact that even ‘normal’ corneas are not perfectly symmetric, and some are not perfectly symmetric especially with regard to the corneal apex.” The FDA clinical trial compared outcomes of standard wavefront-guided procedures to topography-guided procedures in non-aberrated corneas. In that study, nearly 65% of eyes treated with topo-guided LASIK experienced 20/16 or better vision, according to a press release from Alcon. “I think the benefits, if you look at the clinical trial data, are some of the best results I’ve ever seen on virgin eyes,” Dr. Solomon said. What to know before getting started Alcon’s Contoura system uses either the WaveLight Allegretto Wave Eye-Q Excimer Laser System or the WaveLight EX-500 Excimer Laser System together with the WaveLight Topolyzer VARIO Diagnostic System. In conjunction with an education partner, Alcon