Taking LASIK Patients Beyond 20/20 in 2020


In the past, to get top performance out of a high-end supercar you had to be an expert driver. Years of training went into developing subtle skills of braking, clutching, steering, and acceleration. However, over the last decade, technology has made this level of performance accessible to the average driver. Anti-lock braking computers apply threshold and cadence braking. Electronic stability control applies unique braking to each individual wheel to prevent skidding. The result? A better driving experience for everyone, even the average driver.

So, what does this kind of high performance look like for LASIK? For starters, every patient would have an excellent outcome, defined as 20/20 or better vision without glasses or contacts. The quality of their 20/20 or 20/15 (better than 20/20) vision would be exceptional. They would have great vision during the day and at night, and they would be happy! Happy patients love their vision and rave to their friends and family about their LASIK experience. Fortunately, new technology has made this a reality.

In November 2015, a company called Alcon released Contoura, topography-guided LASIK, into the U.S. market. Think of a topographic map used by hikers or the military to view the hills and valleys in a landscape. Now imagine a cornea having hills and valleys, with laser technology to smooth them out and create a perfectly curved surface. To achieve this, Contoura went beyond the standard two corneal measurements to bring over 100,000 topographic data points into the LASIK treatment for each eye. This was coupled with a blazing-fast infrared eye tracker that follows the eye faster than humans can move. Here was a new “LASIK supercar.” And it performed amazingly well in the FDA study with 92.6% of eyes achieving 20/20 vision or better and 64.8% experiencing 20/15 vision or better. Patient vision quality was also improved with significant reductions in glare, light sensitivity, and difficulty driving at night—delivering better night vision than glasses or contacts. This had never been achieved before.

Yet when Contoura was released to the U.S. market, it stalled. The FDA study had no less than three corneal specialists evaluating every cornea and agreeing it had perfect topography, or shape, before it was allowed into the study. It was the equivalent of a professional race car driver piloting a supercar only on perfect roads under perfect conditions with no turns. In the average clinic, life is real and not every cornea is 100% the same. The addition of topographic data led to greater complexity and difficulty determining the correct treatment. Contoura had great power, speed, and potential, but if the average surgeon didn’t understand how to bring it all together, its benefits would be wasted.

Phorcides Analytic Engine software for laser eye surgery
Phorcides Analytic Engine

Photo courtesy NSES

What was needed was new technology to assist the surgeon driving the latest topography-guided laser. I designed Phorcides Analytic Engine software to meet this need. Phorcides uses GIS (geographic imaging software) to pull detailed information about the complex 3D cornea and use it to better treat the patient.

From there, the software applies a series of advanced mathematics, physics, and computer algorithms to determine the best treatment for each eye, resulting in exceptional patient experiences with beautiful vision.

In a recent study from five U.S. clinics examining almost 1,000 eyes treated with Phorcides Contoura LASIK, 100% of eyes achieved 20/25 or better, 98.3% achieved 20/20 or better, and 60.1% achieved 20/15 or better vision without glasses three months after surgery. Over half of the eyes achieved 20/15 or better, which means we are moving the new normal to beyond 20/20 in 2020. In fact, Phorcides-planned topography-guided LASIK produced the best vision for LASIK patients ever recorded. Used across the globe by surgeons in 24 countries on five continents, Phorcides was developed right here in Minneapolis. Something to be proud of.

Two image simulations
Image simulations of a patient with perfect corneal topography (left) and a patient with a small amount of corneal topographic irregularity (right)

Photo courtesy NSES

Great patient outcomes from LASIK go beyond just achieving 20/20 or 20/15 vision. That’s because not all 20/20 vision is the same. Two patients can read a 20/20 line on the eye chart, but they may not see the same crisp outline of each letter. The image simulation above shows a patient with perfect corneal topography on the left and a patient with a small amount of corneal topographic irregularity on the right. Contoura allows for the correction of topographic irregularities and results in clearer, more crisp vision of higher quality.

All of this translates to a better experience for both patient and surgeon. I created Phorcides because I believe LASIK improvements will continue to be made via software, artificial intelligence, and advanced computer analytics that make our current lasers perform better. While these smart software programs will never replace the surgeon, they should make them better at what they do. Augmenting their abilities, much like the high technology in supercars, allows all surgeons to always perform at their best.


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Luke Everdeen

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