Comparison of refractive and visual acuity results after Contoura® Vision topography-guided LASIK planned with the Phorcides Analytic Engine to results after wavefront-optimized LASIK in eyes with oblique astigmatism

PLOS ONE RESEARCH ARTICLE Comparison of refractive and visual acuity results after Contoura® Vision topographyguided LASIK planned with the Phorcides Analytic Engine to results after wavefrontoptimized LASIK in eyes with oblique astigmatism a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Phillip Brunson ID1☯*, Paul M. Mann, II1☯, Paul Michael Mann1☯, Richard Potvin ID2☯ 1 Mann Eye Institute and Laser Centers, Houston, TX, United States of America, 2 Science in Vision, Bend, OR, United States of America ☯ These authors contributed equally to this work. * OPEN ACCESS Citation: Brunson P, Mann PM, II, Mann PM, Potvin R (2022) Comparison of refractive and visual acuity results after Contoura® Vision topography-guided LASIK planned with the Phorcides Analytic Engine to results after wavefront-optimized LASIK in eyes with oblique astigmatism. PLoS ONE 17(12): e0279357. https:// doi.org/10.1371/journal.pone.0279357 Editor: Michael Mimouni, University of Toronto, CANADA Received: August 22, 2022 Accepted: December 6, 2022 Published: December 19, 2022 Copyright: © 2022 Brunson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: This work was supported by an investigator-initiated study grant funded by Alcon (IIT# 66721403). The funder did not play any role in study design, data collection and analysis, decision to publish or preparation of the manuscript. Abstract Purpose To compare visual acuity and refractive results between topography-guided laser in situ keratomileusis (LASIK) planned with the Phorcides Analytic Engine (PAE) to results after wavefront-optimized (WFO) LASIK in subjects with preoperative oblique astigmatism in their manifest refraction. Methods This was a retrospective chart review of clinical results from eyes treated with topographyguided LASIK planned with PAE compared to eyes treated with WFO LASIK using the same Wavelight® excimer laser system. All included subjects had preoperative oblique astigmatism. Residual refractive error and visual acuity (uncorrected and corrected) were the measures of interest, at the visit closest to 90 days postoperative. Results A matched data set from 100 WFO and 97 PAE eyes was extracted from clinical records. At the postoperative visit the PAE group showed lower residual refractive cylinder (p = 0.04), uncorrected distance visual acuity (UDVA) (-0.06 PAE vs. -0.02 WFO, p < 0.01) and distance corrected visual acuity (CDVA) (p < 0.01). The percentage of eyes with a mean refraction spherical equivalent (MRSE) magnitude within 0.25 D and 0.50 D of plano was statistically significantly higher in the PAE group (p = 0.04 and 0.01, respectively). A statistically significantly higher percentage of eyes in the PAE group had UDVA better than or equal to -0.10 logMAR (20/16 Snellen, 36% vs 22%, p = 0.04). More eyes gained CDVA after surgery in the PAE group (53% vs 32%, p < 0.01). There were five enhancements in PLOS ONE | https://doi.org/10.1371/journal.pone.0279357 December 19, 2022 1/9 PLOS ONE Competing interests: Drs. Brunson and Potvin are consultants to Alcon. The authors report no other conflicts of interest in this work. This work was supported by an investigator-initiated study grant funded by Alcon (IIT# 66721403). This does not alter our adherence to PLOS ONE policies on sharing data and materials. Clinical results after topography-guided LASIK with Contoura(R) and Phorcides(R) vs wavefront-optimized LASIK the WFO group versus none in the PAE group, a statistically significant difference (p = 0.03). Conclusions Visual acuity and refractive outcomes after LASIK using PAE in eyes with oblique astigmatism in their preoperative refraction were statistically significantly better than those obtained when WFO treatment was used. The number of refractive outliers and the number of retreatments were also significantly lower with PAE treatment. Introduction Laser in situ keratomileusis (LASIK) is one of the most common corneal surgical refractive procedures in use today, providing excellent results with a good safety profile [1]. However, a small percentage of patients may be dissatisfied. One of the recognized contributors to dissatisfaction after LASIK is residual refractive error, particularly residual astigmatism, or irregular astigmatism after surgery [2, 3]. In these instances, a retreatment is often helpful in improving the patient’s level of satisfaction [3]. Treating astigmatism can be challenging because while the manifest astigmatism is generally the target treatment, results appear slightly less predictable if the source of astigmatism is not the anterior cornea [4]. The orientation of the astigmatism may also affect the predictability of results. Astigmatism may be classified by its axis as with-the-rule (WTR), against-the-rule (ATR), or oblique. Generally, WTR is more common than ATR and ATR is more common than oblique astigmatism. Oblique astigmatism is estimated to account for 10–20% of all astigmatism (corneal and manifest) in the general population across all age groups [5, 6]. Compared to ATR and WTR, oblique astigmatism appears to cause more difficulties in binocular perception [7], may decrease reading performance [8], result in lower distance visual acuity [8], and reduced contrast (compared to WTR) [9]. In addition, oblique astigmatism is more likely to be irregular than WTR or ATR astigmatism [10]. Subjective blur limits for oblique astigmatism have also been reported to be lower (worse) than when astigmatism is WTR [11]. The orientation of astigmatism is also known to be a factor influencing refractive surgery results. Outcomes after cataract surgery and toric IOL implantation tend to be more variable in eyes with oblique astigmatism relative to eyes with ATR or WTR astigmatism [12]. One study of correcting astigmatism with a corneal refractive procedure suggests results are also more variable when the astigmatism is oblique [13]. We could locate no studies of LASIK outcomes where results were stratified by astigmatism orientation. Topography-guided LASIK procedures were originally developed as a method to correct irregular astigmatism [14]. Given that oblique astigmatism tends to be more irregular [10], the ability of topography-guided LASIK procedures to correct oblique astigmatism may be better than for other LASIK procedures, such as wavefront-optimized (WFO) LASIK. The Contoura1 Vision procedure (Contoura, Alcon Vision LLC, Fort Worth, TX, USA) is a topography-guided LASIK procedure that is used to treat cases of both irregular and regular astigmatism. Clinical trial results submitted for the Food and Drug Administration (FDA) approval of Contoura reported good visual outco (...truncated)