April 14, 2018
Contoura Vision Topography-guided Laser Correction, popularly called Contoura Vision LASIK for vision correction, is the latest technology that has been made commercially available after US FDA approval in 2016. It is a topography-guided LASIK treatment system, that is, the LASIK performed for vision correction is guided in great detail by the surface characteristics or topography of the cornea. The technology uses the WaveLight Allegretto Wave Eye-Q or WaveLight EX500 Excimer Laser Systems, along with the WaveLightTopolyzerVario Diagnostic Device (manufactured by Alcon, USA). These machines map all the surface imperfections in individual corneas at over 20000 data points and evaluate each one of them independently for vision correction which means that the final result is more precise and sharper vision, along with a better quality of vision. In the short time since its introduction, its popularity has been phenomenal, with both patients and doctors preferring Contoura Vision over conventional (wavefront and aspheric) LASIK and even SMILE, even in India.
Contoura Vision does offer additional benefits over SMILE and LASIK for patients. A brief overview of current experience with the technology:
All laser surgeries for vision correction, Contoura Vision, SMILE and Femtosecond LASIK and conventional LASIK are effective, safe and predictable. Of these, as per currently available data, the best quality of vision correction is provided by Contoura Vision.
All of the variants of the laser vision correction procedures, over time, give similar visual results; however, the fastest vision recovery is expected after Contoura Vision.
SMILE has been promoted as the vision correction surgery that causes the least dryness after surgery, and therefore, may be preferred in patients with pre-existing dry eyes. However, current data shows that the real-life use of tear supplements after Contoura Vision is no more than after SMILE. This implies that the induced dryness may not really be a differentiator between these two surgical procedures.
Postoperative aberrations including annoying visual symptoms like glare, sensitivity to light, and difficulty in driving at night occur less frequently after Contoura vision due to better, more precise ablation that is customized to the individual cornea.
Contoura Vision is also approved by the US FDA for correction of astigmatism up to 3 Diopters, while SMILE is only approved for up to 0.5 Diopters of cylindrical correction.
Also, some of the clinical trial results published by Kanellopoulos et al in the critically acclaimed journal, the Journal of Refractive Surgery in 2017 has shown why Contoura Vision is showing more promising results over other laser vision correction procedures.
Contoura reported that 86.4% of the Contoura Vision LASIK group and 68.2% of the SMILE group had a vision of 20/20 and 59.1% and 31.8%, respectively, had vision of 20/16. This implies that “super vision” or vision better than 100% was achieved in more than half the patients getting Contoura Vision.
The results obtained from the FDA clinical trials are as promising and parallel to those of individual surgeons. These include:
Almost all of the patients who had their vision corrected by Contoura Vision LASIK said they would choose it again for themselves. In fact, this figure was an overwhelming 98% in the FDA clinical trials. Most patients would be happy to recommend it to their friends and relatives.
One-third of the eyes had better-unaided vision after the procedure than they had with glasses or contacts before surgery in the FDA trials. 40% of these patients had vision better than 6/6 or 20/20 which is considered normal for human beings. Most surgeons report as many as half the patients gaining at least one line of vision after the surgery, a phenomenon known as super vision.
Most of the FDA trial patients reported a significant decrease in annoying visual symptoms like glare, sensitivity to light, and difficulty in driving at night in comparison to their glasses. Most surgeons agree that the visual disturbances after Contoura Vision LASIK are significantly less than after LASIK or SMILE, and the patients are much happier with their quality of vision.
An added advantage of the technique is the comfort factor with the technology itself. Even the most nervous of patients find the fact that it is bladeless reassuring, and are wowed by the instant improvement in vision. Eye surgeons are reassured by the fact that the technology has the fastest tracker which means proper centration of the ablation, customized to over 22000 data points, each time.
The most wonderful part of the Contoura Vision experience is that results from Indian patients are pouring in. There are three centers in Delhi, and NCR, which actually offer Contoura Vision technology for spectacle removal.
The Eye 7 hospitals have now had experience with the technology for over a year. Its founder director, Dr. Sanjay Chaudhary, performed the first Contoura Vision surgery in the region in 2017. Since then, the center has disclosed its excellent results in various communications. In fact, since Contoura Vision technology has shown such promising results over SMILE and LASIK, it has recently also been acquired by Dr. R P Centre for Ophthalmic Sciences at AIIMS, which is the apex institute for eye diseases and vision correction in the country.
Contoura vision gives results superior to LASIK, SMILE and even glasses and contact lenses
With the introduction of Contoura Vision technology for laser vision correction, a new word has become a part of the patients’ dictionary: super vision. In fact, most people, patients and doctors alike, are now aware that Contoura Vision gives results superior to LASIK, SMILE and even glasses and contact lenses, and the buzzword is super human vision or super vision. Vision better than 6/6 or 20/20 is called super vision or super human vision.Normal human vision is delineated as 6/6 or 20/20. If your vision is 6/6 it means that you can see from 6 meters distance, what a normal human being is expected to see at 6 meters. 6/12 vision implies that you can see from 6 meters what a normal person can see from 12 meters (that is, you need to be closer to an object to be able to see it clearly, and obviously, need a correction of vision). In other words, it is also described as 20/20 vision, which is the equivalent of the metric 6/6.An eagle, for instance, has a 20/4 vision, that is, an eagle can see from 20 meters, what a normal human being can only see from 4 meters away. This is beyond human ability, which is what enables the eagle to spot its prey from very far away.
All three techniques, Contoura Vision, LASIK, and SMILE, have US FDA approval, which means they are all efficacious and safe for laser vision correction, and provide excellent results in patients who do not want to wear spectacles.
In addition to FDA trials, doctors have continued to publish their results in medical journals to share their experiences with their colleagues, and these are available online also.
The results of Kanellopoulos et al published in the critically acclaimed journal, the Journal of Refractive Surgery in 2017 clearly established the superiority of Contoura Vision over SMILE. They found that 86.4% of the LASIK group and 68.2% of the SMILE group had a vision of 20/20 and 59.1% and 31.8%, respectively, had vision of 20/16 (super vision).
Which implies that vision better than 100% was achieved in more than half the patients getting Contoura Vision – SUPER VISION
Especially in case of astigmatism, or correction of cylinder, Contoura Vision was much better than SMILE, which is why it has been approved for correction of up to 3 diopters of cylindrical power.
In fact, the authors are of the view that ContouraVision was superior in all visual performance parameters studied, both subjective and objective, including visual aberrations.