Wavefront- and Topography-Guided Laser Treatment
Suitability assessment and planning with Dr. Nejmi Öztürk, ophthalmologist and eye surgeon, at HG Hospital in Kahramanmaraş, Türkiye — customized laser profiles added to LASIK, PRK and No-Touch
- What wavefront- and topography-guided laser is; how it differs from standard laser
- Who gains extra benefit (night halos, irregular astigmatism) and who does not need it
- Measurements, steps of the procedure, recovery and risks
- Combination with CXL in keratoconus; assessment and planning in Kahramanmaraş
What is wavefront- and topography-guided laser?
Wavefront- and topography-guided laser refers to customized treatment profiles for laser eye surgery (refractive laser) in which the map of tissue the laser will remove from the cornea (the clear front layer of the eye) is prepared not only from your glasses prescription but from measurements specific to that eye. It is not a separate operation in itself; it is added to the laser step of the LASIK, PRK or No-Touch methods.
Standard laser corrects the myopia (nearsightedness), hyperopia (farsightedness) and astigmatism values measured for glasses (the lower-order refractive errors). Yet every eye also has fine irregularities that glasses cannot correct; these are called higher-order aberrations, and they can cause night halos, glare and reduced contrast. Customized profiles take these into account as well.
What is wavefront-guided laser?
In wavefront-guided laser, a device called an aberrometer measures how light sent into the eye returns from the retina and produces a map of the refractive errors of the eye’s entire optical system (cornea and lens together); the laser profile is prepared from this map. The aim is to reduce the higher-order aberrations that are already present. A “wavefront-optimized” profile, on the other hand, does not use an individual measurement; it is a standard correction designed to preserve the natural shape of the cornea and is the default setting on many laser systems.
What is topography-guided laser?
In topography-guided laser the data source is corneal topography: from thousands of elevation points taken from the front surface of the cornea, a profile is prepared that will make the surface more regular. It comes to the fore when the source of the problem lies in the cornea, that is, in irregular astigmatism, a decentered treatment after previous laser, or a small optical zone. In keratoconus (thinning and bulging of the cornea), the version combined with cross-linking is called “topography-guided PRK”.
Who gains extra benefit from customized laser?
A customized profile provides extra benefit in eyes where standard laser may not give a sufficient result; the general suitability conditions for laser apply here too.
- Eyes with a high level of higher-order aberrations: If aberrometry shows marked irregularity, a wavefront-guided profile is considered.
- Large pupils and expectations for night vision: People who drive at night; the profile aims to reduce night halos and glare.
- High or irregular astigmatism: A topography-guided profile reduces the irregularity in the cornea.
- Complaints after previous laser: Topography-guided additional correction for a decentered treatment or a small optical zone.
- Selected cases of keratoconus: Together with cross-linking, limited topography-guided PRK to reduce the irregularity (combined CXL-laser).
Who is it not suitable for, or who does not need it?
- Eyes with a regular cornea and low aberrations; a standard or wavefront-optimized profile gives a similar result, and the extra benefit is limited.
- Eyes in which a reliable measurement cannot be obtained: advanced dry eye, corneal scarring, very small pupils, or being unable to hold a steady gaze during the measurement.
- Eyes for which SMILE is planned; customized profile options are limited in SMILE.
- Progressive keratoconus; it is considered only together with cross-linking, removing very little tissue, and in selected cases. The aim is not freedom from glasses but to regularize the cornea.
- The general obstacles to laser: thin cornea, pregnancy and breastfeeding, a changing prescription, cataract, an active eye infection, and diseases that impair wound healing.
Examination and tests
In customized laser, the quality of the measurement determines the quality of the treatment; for this reason some measurements are repeated several times and the examination takes a little longer.
- Prescription measurement without and with drops (cycloplegic refraction).
- Aberrometry (wavefront measurement): a map of the eye’s total refractive error; taken with the pupil dilated.
- Corneal topography and tomography: maps of the front and back surfaces, screening for keratoconus; the topography-guided profile is prepared from this data.
- Pachymetry: corneal thickness; the tissue that will remain is calculated carefully.
- Pupillometry: pupil diameter in the dark; the optical zone is planned accordingly.
- Tear tests, eye pressure measurement and a dilated retinal examination (with the pupil widened).
How is customized laser treatment performed?
The procedure follows the method to which the profile is added (LASIK, PRK or No-Touch); the customized part is the planning and the stage in which the laser recognizes the eye.
- The aberrometry or topography data is transferred to the laser planning software; the surgeon checks the amount of tissue to be removed and the optical zone, and approves the profile.
- On the day of the procedure the eye is numbed with anesthetic drops; a small device is placed to keep the eyelids open.
- Using iris recognition, the laser matches the eye to its position during the measurement; the slight rotation of the eye when lying down is also taken into account. This step is important for placing the axis of the astigmatism correctly.
- Depending on the chosen method, a flap is prepared (LASIK) or the epithelium is removed (PRK, No-Touch); the customized profile is then applied with the excimer laser. The laser time may be a little longer.
- The flap is laid back in place or a bandage lens is fitted; antibiotic drops are applied. The discomfort felt varies from person to person.
Customized laser step by step
From measurement to treatment plan to the laser itself, shown schematically on a cross-section of the cornea.
- Measurement and mappingWavefront analysis measures the aberrations of the whole optical system of the eye; corneal topography measures the shape of its surface. The two are read together.
- Deriving the individual planFrom these measurements an ablation profile is calculated that accounts not only for the spectacle prescription but also for the irregularities.
- Applying the laserThe laser applies that profile to the cornea. The aim is to reduce quality-of-vision problems such as night glare and halos compared with a standard treatment.
EpitheliumStromaArea the laser acts on
What is recovery like?
Recovery follows the timeline of the method to which the profile is added: in LASIK vision usually clears within 24 hours, in PRK and No-Touch within 1–4 weeks. The expected reduction in night halos becomes noticeable over the following months, as healing is completed.
- Day 1: Depending on the method, burning, watering and light sensitivity; the drops are used as prescribed.
- Week 1: Do not rub your eyes, keep water out of your eyes and do not wear eye make-up; in surface laser the bandage lens is removed on day 3–5.
- Month 1: Stay away from swimming pools, the sea, Turkish baths (hamam) and saunas; in surface laser the steroid (cortisone) drops continue at a gradually reduced dose.
- Months 3–6: Stability of vision and the aberration measurements are assessed.
Check-ups are usually on day 1, at week 1, at month 1 and at month 3. For patients coming from Elbistan and the surrounding districts, the check-up dates are planned together at the examination, taking the travel time into account.
What are the risks and limitations?
A customized profile does not remove the risks of the method it is applied with; it also has limitations of its own.
- The method’s own risks remain: Dry eye, night halos, under- or over-correction, infection, haze (in surface laser) and flap problems (in LASIK) can occur.
- Measurement error: Dry eye, blinking or a shift of gaze can spoil the measurement; if the measurements are inconsistent, a customized profile is not used.
- More tissue: A wavefront-guided profile may remove a little more corneal tissue in some eyes; this can be a limiting factor in thin corneas.
- Night halos may not disappear completely: The aim is to reduce them; with large pupils and high prescriptions some halos may remain.
- Mismatch between prescription and cornea: If the corneal astigmatism differs from the astigmatism in the glasses prescription, topography-guided planning is more complex; sometimes a small residual prescription remains.
- Limits in keratoconus: Combined treatment reduces the irregularity but may not entirely remove the need for glasses or contact lenses; the step that halts progression is cross-linking.
How do standard, wavefront-guided and topography-guided laser compare?
The measurements determine the choice of profile; in most regular eyes a standard or wavefront-optimized profile is sufficient.
| Profile | Data source | Aim | Who it is for | Limits |
|---|---|---|---|---|
| Standard / wavefront-optimized | Glasses prescription | To correct myopia, hyperopia and astigmatism without creating new aberrations | Regular cornea, low aberrations | Does not correct existing higher-order aberrations |
| Wavefront-guided | Aberrometry: a map of the eye’s total refractive error | To reduce higher-order aberrations | Marked aberrations, large pupils, expectations for night vision | Requires a reliable measurement; may remove a little more tissue |
| Topography-guided | Corneal topography: surface map | To regularize the corneal surface | Irregular astigmatism, problems after previous laser, combined with CXL in keratoconus | Planning is difficult when prescription and cornea do not match; limited in hyperopia |
Standard laser is not applied to eyes with keratoconus; the options are described on the keratoconus treatment and cross-linking pages. For high prescriptions that are not suitable for laser, ICL is considered.
Assessment and planning in Kahramanmaraş
Your suitability for wavefront- or topography-guided laser is assessed with the examination and measurements at HG Hospital in Kahramanmaraş, Türkiye; the method and profile that suit you are planned together with Dr. Nejmi Öztürk. Dr. Öztürk is an ophthalmologist working in cataract and refractive surgery; he sees patients at HG Hospital (Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, 46050 Onikişubat / Kahramanmaraş).
HG Hospital is a private hospital contracted with the Turkish social security institution (SGK); patients with valid SGK coverage may use it, although a private-hospital co-payment may apply. Refractive laser surgery to reduce the need for glasses is, however, generally not covered by SGK, and most private health insurance policies also exclude it; cross-linking for keratoconus may be covered by SGK under certain conditions. Patients without SGK coverage, such as international patients and visitors from abroad, pay privately or through their private or travel health insurance; the hospital checks coverage before treatment. Fee information is given by the hospital after the examination, and insurance coverage is clarified at the consultation.
For patients coming from Elbistan, Afşin, Göksun, Ekinözü and Nurhak, the examination and measurements are planned so that they can be completed on the same day; the drive between Elbistan and Kahramanmaraş takes about 2 hours. Dr. Öztürk does not see patients in Elbistan; for travel and check-up planning, see the patients from Elbistan and the surrounding area page.
Dr. Nejmi Öztürk sees patients at HG Hospital in Kahramanmaraş, Türkiye. For patients travelling from other districts or from abroad, examination, tests and treatment planning can be arranged for the same day.
Hospital switchboard (within Türkiye): 444 46 46 · E-mail: info@nejmiozturk.com · HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş, Türkiye
Frequently asked questions
What is the difference between wavefront laser and standard laser?
Standard laser corrects the glasses prescription; wavefront-guided laser also takes into account the fine errors measured by aberrometry that glasses cannot correct. In regular eyes the results of the two are similar; the difference becomes apparent in eyes with a high level of aberrations.
Does customized laser prevent night halos?
The aim is to reduce night halos and glare; it cannot be said that it prevents them completely. With large pupils and high prescriptions some halos may remain; in most patients the halos decrease within a few months.
Can irregular astigmatism be corrected with laser?
In irregular astigmatism, a topography-guided profile aims to reduce the irregularity in the cornea. If the cause of the problem is keratoconus, standard laser is not applied; only a limited treatment combined with cross-linking is considered. The decision is based on the topography and tomography measurements.
Is topography-guided laser done in keratoconus?
In selected cases it can be done together with cross-linking, removing very little tissue from the cornea. The aim is not freedom from glasses but to regularize the cornea and improve the quality of vision; suitability is determined by the corneal thickness and the stage of the disease.
Can customized laser be done with SMILE?
Wavefront- and topography-guided profile options are limited in SMILE. In eyes that need a customized profile, LASIK or surface laser (PRK, No-Touch) is preferred.
How much does wavefront laser cost?
Fee information is given by the hospital after the examination; because the method, the profile and the scope of tests are decided individually, no figure is given in advance. Insurance coverage is clarified at the consultation.
Is customized laser covered by SGK or private insurance?
Refractive laser surgery to reduce the need for glasses is generally not covered by SGK, and most private health insurance policies also exclude it. Cross-linking for keratoconus may be covered under certain conditions. Patients without SGK coverage pay privately or through their private or travel health insurance; coverage is clarified at the consultation.
I am coming from Elbistan; how many times do I need to come for the measurements?
Dr. Nejmi Öztürk does not see patients in Elbistan; the examination and measurements are grouped into the same day at HG Hospital in Kahramanmaraş. If the measurements need to be repeated because of dry eye, a second visit may be requested; the check-up plan is made together at the examination.
Sources
- Turkish Ophthalmological Society — todnet.org
- American Academy of Ophthalmology (AAO) — aao.org
- European Society of Cataract and Refractive Surgeons (ESCRS) — escrs.org
- National Eye Institute (NEI) — nei.nih.gov
Related pages
- Laser eye surgery — all methods
- Combined CXL-laser for keratoconus
- LASIK and Q-LASIK eye surgery
- PRK laser eye surgery
This page is for information only; diagnosis and treatment decisions are made after an examination. The results of any surgical or interventional procedure may vary from person to person. You are advised to obtain detailed advice from your physician before any procedure.
Ophthalmologist and eye surgeon. Graduate of Erciyes University Faculty of Medicine; completed his residency at Ankara Atatürk Training and Research Hospital. With 21 years of experience in cataract and refractive surgery, strabismus, glaucoma, retina and oculoplastic surgery, he sees patients at HG Hospital in Kahramanmaraş, Türkiye. Biography and training
Dr. Nejmi Öztürk
Ophthalmologist and eye surgeon
HG Hospital, Üngüt Mevkii, Prof. Dr. Necmettin Erbakan Blv. No:209, Onikişubat / Kahramanmaraş
+90 506 377 47 68WhatsAppAppointment formHospital switchboard (within Türkiye): 444 46 46 · info@nejmiozturk.com
- Private patients and private health insurance are welcome; patients with SGK coverage may use it (conditions are confirmed by the hospital)
- Same-day examination and test planning for patients travelling from other districts or from abroad
- Getting here and patient information
- Patients from Elbistan and the region