Prior LASIK/PRK Repair

A small but significant number of patients have sub-optimal outcomes after prior LASIK or PRK surgery. A small number of these patients end up with severe visual problems that do not get diagnosed properly. These patients can also be the ones that receive public and media attention. Virtually all of these patients can have their corneas repaired and their visual problems treated utilizing the CREATE Protocol (Corneal Repair Epithelium and Topography Enhanced), which utilizes a patented process to treat the corneal irregularity measurable by the topography guided ablation (Contoura) system, as well as the part the irregularity that system cannot measure hidden by epithelial compensation. Treatment of both of these parts is part of a patent granted by the U.S. Patent Office to Dr. Motwani (European Patents Pending).

Suboptimal outcomes from prior LASIK/PRK procedures or often related to de-centered laser ablations from the original procedure. It is even possible to visualize where the laser tracked and performed laser partially on one area, changed or lost tracking, and the laser moved to another area creating a very irregular cornea. Over time the corneal epithelium will thicken and thin over low and high areas to compensate for the irregularity, leading to a correction that “fades” over time. This epithelial compensation must be accounted for, which is part of the CREATE Protocol

Dr. Motwani has also published data demonstrating that a certain type of cornea undergoes a one-time corneal shape change when a LASIK flap is made, leading to an incorrect laser irregular laser shape being created. This can lead to significant visual issues such as glare, halos, and ghosting. This biomechanical change happens only when the initial flap is made. The incorrect, irregular laser ablation shape created can be repaired and the corneal shape returned to normal.

Treatment is in two phases. Phase 1 treats the corneal irregularity and makes a more uniform shape repairing the irregularity of the cornea. Included in this repair is the significant portion of the irregularity masked by epithelial compensation, which topography guided ablation (market name Contoura) cannot measure. This laser procedure, the CREATE Protocol, has been granted a patent by the U.S. Patent Office to Dr. Motwani (European Patents Pending). This will create a cornea that is no longer multifocal, and has one central shape and power. As it is not possible to accurately predict the power of the cornea once it is made more uniform, treatment of the residual refractive error is performed in Phase 2. This typically occurs 4 months later and performs full correction of the refractive error, and also can included balanced monovision to allow for reading without reading glasses in those over 40 years of age.

Since it is a surface procedure, healing takes 3-5 days after each phase where a bandage contact lens is utilized. In between phases patients can get glasses after 1-2 weeks to aid with vision and return to work. If patients have significant cataract formation, it is recommended that they get cataract surgery during this interim period at least 2 weeks post Phase 1, and any residual refractive error can be corrected in Phase 2.

The goal is to create an entirely new corneal shape that is close to the more uniform shape created with the LYRA Protocol, and have a cornea that looks similar to a primary procedure that was performed by Dr. Motwani.