Contoura vs. LASIK
Understanding Contoura and LASIK
Standard LASIK at most centers uses a wavefront-optimized ablation profile to minimize induction of spherical aberration. Some practices also offer wavefront-guided LASIK that uses aberrometry of the whole optical system. In all cases, an excimer laser reshapes the cornea to correct your refractive error.
During the procedure, our eye doctor creates a thin flap in the cornea, then uses the excimer laser to reshape the underlying tissue. The goal is to help light focus properly on your retina, giving you clearer vision without corrective lenses.
Contoura Vision is a topography-guided form of LASIK that uses detailed corneal mapping to customize the treatment on the WaveLight platform. This approach maps up to 22,000 unique points on your cornea to create a detailed picture of its surface.
The laser then corrects not only your prescription but also subtle irregularities in the corneal surface itself. This personalized approach can address imperfections that standard wavefront-optimized LASIK does not measure or treat.
Topography-guided LASIK relies on a detailed map of your cornea rather than just your prescription. Think of it like the difference between a flat map and a 3D terrain model.
- Standard LASIK treats your eye based on sphere, cylinder, and axis measurements from your glasses prescription
- Contoura captures thousands of elevation points to identify even minor surface irregularities
- The laser treatment plan accounts for the unique topography of each individual cornea
- This approach may produce sharper, clearer vision in some patients, especially in low-light conditions
Wavefront-guided LASIK uses a customized map of the eye's aberrations measured by an aberrometer, which can be helpful in selected eyes with higher-order aberrations. This differs from topography-guided LASIK, which uses corneal surface data rather than whole-system optical data.
- Wavefront-optimized: reduces induction of spherical aberration using corneal curvature data
- Wavefront-guided: treats measured higher-order aberrations of the entire optical system
- Topography-guided (Contoura): treats manifest refraction and corneal surface irregularities based on corneal maps on the WaveLight platform
Both standard LASIK and Contoura begin with creating a corneal flap using either a microkeratome blade or a femtosecond laser. Most surgeons now create the flap with a femtosecond laser rather than a microkeratome. Both use an excimer laser to reshape corneal tissue, and both have similar recovery timelines.
The fundamental goal is the same: to reduce your dependence on glasses or contact lenses. Both procedures are performed on an outpatient basis and typically take less than 30 minutes for both eyes.
Who Is a Good Candidate for Each Procedure
LASIK platforms can treat myopia, hyperopia, and regular astigmatism within platform-specific ranges. In the United States, Contoura topography-guided treatment is FDA approved for myopia with or without regular astigmatism and is not approved for hyperopia.
Typical treatment ranges vary by platform and your anatomy.
For standard LASIK (wavefront-optimized or wavefront-guided):
- Myopia up to about -10.00 to -12.00 diopters, depending on corneal thickness
- Hyperopia up to about +4.00 to +6.00 diopters
- Astigmatism up to about 5.00 to 6.00 diopters
- Stable prescription for at least one to two years
For Contoura topography-guided treatment in the U.S.:
- Myopia typically up to about -9.00 diopters with up to about -3.00 diopters of regular astigmatism
- Adequate corneal thickness and regular, stable topography
- Not approved for hyperopia
We may recommend Contoura when your corneal topography is regular but shows measurable surface irregularities or when your higher-order corneal aberrations are likely to benefit from a topography-guided profile.
Contoura is not recommended for keratoconus, corneal ectasia, or unstable corneas. In eyes with disease-related irregular astigmatism, topography-guided PRK with or without corneal cross-linking may be considered off-label rather than LASIK.
Those who have experienced poor night vision, halos, or glare with glasses may also see better results with topography-guided correction. Contoura can sometimes address visual symptoms that standard LASIK cannot fully resolve.
Your corneas must be thick enough to safely remove tissue during laser reshaping. We measure corneal thickness during your evaluation to ensure adequate tissue will remain after surgery.
Healthy tear production is important because dry eyes can worsen after any LASIK procedure. We also check for signs of keratoconus, corneal scarring, or other structural problems that might affect healing or outcomes. We use corneal tomography and other screening tools to detect early keratoconus or biomechanical weakness.
Most surgeons prefer patients to be at least 18 years old, though many recommend waiting until age 21 or older. Your prescription should be stable for at least one to two years before surgery.
- Younger patients may still have changing prescriptions as their eyes mature
- Hormonal changes, pregnancy, or certain medications can cause temporary prescription shifts
- Stable vision ensures that the correction we perform will last for years
Certain eye conditions and health problems can make LASIK or Contoura unsafe or less effective. We screen carefully to protect your eye health and ensure realistic expectations.
- Active eye infections, inflammation, or severe dry eye disease
- Keratoconus, corneal ectasia, or thin corneas
- Uncontrolled diabetes, autoimmune disorders, or immunosuppression
- Pregnancy or nursing, due to temporary vision and hormonal changes
- Visually significant cataracts, poorly controlled glaucoma, or unstable retinal disease
Some conditions are relative rather than absolute contraindications and may still be eligible after specialist clearance and careful risk assessment.
Testing and Choosing the Right Procedure for Your Eyes
Your evaluation begins with a thorough eye exam to measure your current prescription and assess your overall eye health. We check your visual acuity, eye alignment, and how well your eyes work together.
We also examine the front and back of your eyes using specialized instruments. This helps us identify any conditions that might affect your candidacy or require treatment before surgery.
Corneal topography creates a detailed color-coded map of your corneal surface. This test takes only a few seconds and is completely painless.
- The device projects light rings onto your cornea and photographs the reflection
- Computer analysis identifies areas that are steeper or flatter than average
- The map reveals patterns of regular or irregular astigmatism
- This information is essential for planning Contoura treatment and screening for keratoconus
We measure your pupil size in different lighting conditions because larger pupils can increase the risk of nighttime glare or halos. Wavefront analysis measures how light travels through your entire optical system.
This testing identifies higher-order aberrations that your glasses prescription does not correct. The combination of pupil measurement and wavefront data helps us predict how you might see after surgery, especially at night. Modern lasers use larger optical zones and aspheric profiles, which lessen but do not eliminate the risk of night symptoms in patients with large pupils.
After gathering all your test results, we analyze your corneal shape, prescription, lifestyle needs, and visual goals. If your corneas are smooth and regular, standard wavefront-optimized LASIK may provide excellent results at a lower cost.
If your topography shows irregularities or you have significant higher-order aberrations, we may recommend Contoura for a more personalized treatment. Your candidacy for each option depends on the unique combination of factors found in your examination.
The Procedures: What to Expect
Before surgery, you will stop wearing contact lenses for a period ranging from several days to several weeks, depending on the type you wear. This allows your corneas to return to their natural shape for accurate measurements.
- Soft spherical lenses: stop 1 week before final measurements
- Soft toric lenses: stop 2 weeks before final measurements
- RGP or hybrid lenses: stop 2 to 4 weeks, sometimes longer, until topography is stable
- Orthokeratology: may require several weeks or more of discontinuation until corneal shape stabilizes
Additional preparation steps include the following.
- Arrange for someone to drive you home after the procedure
- Avoid wearing eye makeup, lotions, or perfumes on surgery day
- Eat a light meal beforehand unless instructed otherwise
- Bring sunglasses to wear after the procedure, as your eyes may be light-sensitive
On the day of surgery, we numb your eyes with anesthetic drops so you will not feel pain. A device gently holds your eyelids open while you focus on a small light.
The surgeon creates a thin flap in your cornea using a laser or precision blade. The flap is lifted, and the excimer laser reshapes the tissue underneath according to your prescription. Finally, the flap is repositioned, where it adheres naturally without stitches.
The Contoura procedure follows the same basic steps as standard LASIK. The main difference is that the excimer laser uses the topography map to guide the treatment pattern.
Instead of applying a uniform correction based solely on your prescription, the laser makes thousands of tiny adjustments based on your corneal surface data. This customized approach can smooth out irregularities while also correcting your refractive error.
You should not feel pain during either procedure because of the numbing drops. You may feel slight pressure when the flap is created, but this lasts only a few seconds.
Some patients notice a mild burning or scratchy sensation for a few hours after the numbing wears off. Most people describe the discomfort as similar to having an eyelash in the eye, and it typically improves quickly with rest and prescribed eye drops.
The actual laser treatment for each eye takes less than a minute in most cases. The entire process, including preparation and both eyes, usually takes 15 to 30 minutes.
- Time for positioning and numbing drops: about 5 minutes
- Flap creation: 10 to 30 seconds per eye
- Laser reshaping: 10 to 60 seconds per eye, depending on your prescription
- Aftercare instructions and initial recovery: about 10 minutes
Plan to be at the center for 60 to 120 minutes to allow for check-in, verification, and post-operative instructions.
Risks, Side Effects, and Complications
Most patients experience mild temporary side effects during the healing period. These are normal and expected parts of the recovery process.
- Dryness, burning, or foreign body sensation for several weeks
- Fluctuating or hazy vision during early healing
- Glare, halos, and starbursts at night that usually improve over time
- Light sensitivity
- Mild discomfort for the first day
Although serious complications are uncommon, they can occur. We screen carefully to minimize these risks and monitor you closely after surgery.
- Infection or significant inflammation, including diffuse lamellar keratitis
- Flap-related issues, such as striae or epithelial ingrowth
- Overcorrection or undercorrection, sometimes requiring enhancement
- Irregular astigmatism or decentration
- Corneal ectasia in predisposed corneas despite screening
- Persistent dry eye symptoms
- Rare neuropathic ocular pain
LASIK and Contoura provide lasting results, but your eyes will continue to change naturally over time. Understanding these factors helps set realistic expectations.
- Natural changes in vision with aging, including presbyopia after about age 40
- Possible regression, more likely with higher prescriptions
- Enhancement rates vary by age and prescription; most practices see low single-digit rates within the first year
Recovery and Aftercare
Your vision may be blurry or hazy immediately after surgery, but many patients notice improvement within a few hours. You should go home and rest with your eyes closed as much as possible during the first day.
We provide protective eye shields to wear while sleeping to prevent accidental rubbing. Avoid touching or rubbing your eyes, even if they feel itchy or irritated, to allow the corneal flap to heal properly. Do not drive until you are examined and cleared at your first post-operative visit.
You will receive several types of eye drops to use during your recovery. Antibiotic drops prevent infection, while anti-inflammatory drops reduce swelling and promote healing.
- Antibiotic drops are typically used four times daily for about one week
- Anti-inflammatory or steroid drops may be used for one to four weeks, with frequency tapering over time
- Preservative-free artificial tears should be used frequently to keep your eyes moist and comfortable
- Exact regimens vary by surgeon and platform. Follow the instructions we provide and do not change or stop drops without our guidance
Protecting your eyes during the healing process is critical for achieving the best results. Avoid swimming pools, hot tubs, and natural bodies of water for at least two weeks to reduce infection risk.
You can usually return to work and light activities within one to three days, but avoid strenuous exercise, contact sports, or activities that could result in eye trauma for at least one to two weeks. Wear sunglasses outdoors to protect your eyes from bright light and debris.
- Keep water out of your eyes for the first 24 to 48 hours; avoid direct shower spray to the eyes
- No eye makeup for at least 1 week
- Avoid dusty, dirty, or smoky environments for 1 week
- No rubbing or pressure on the eyes for at least 1 month
- Non-contact sports can usually resume in 1 to 2 weeks; contact or high-impact sports typically after 4 weeks with eye protection
- Pools and hot tubs: avoid for at least 2 weeks; lakes and ocean: 3 to 4 weeks
Your first follow-up visit is usually scheduled for the day after surgery. We check your vision, examine the corneal flap, and ensure that healing is progressing normally.
Additional visits are typically scheduled at one week, one month, three months, and six months after surgery. These appointments allow us to monitor your vision improvement and address any concerns promptly. We will adjust the schedule based on your healing and any symptoms.
While complications are rare, certain symptoms require immediate attention. Contact our office right away if you experience any of the following warning signs.
- Sudden vision loss or a significant decrease in vision
- Severe eye pain that does not improve with rest or over-the-counter pain relievers
- Increasing redness, discharge, or signs of infection
- Flashes of light, new floaters, or a curtain or shadow in your visual field
- The sensation that the corneal flap has moved or wrinkled
Comparing Results and Effectiveness
Most patients notice clearer vision within the first 24 hours after either LASIK or Contoura. Your vision may fluctuate during the first few weeks as your eyes heal and adjust.
Significant improvement usually occurs within the first week, with continued refinement over the next one to three months. Final visual results are typically stable by three to six months after surgery.
Clinical studies show that both standard LASIK and Contoura achieve excellent visual outcomes for most patients. The majority of people achieve 20/20 vision or better after either procedure.
Contoura has been shown in some studies to produce a slightly higher percentage of patients achieving 20/15 vision or better. However, individual results vary based on your original prescription, corneal characteristics, and healing response. Group differences between topography-guided and standard LASIK are generally modest and may not be noticeable to every individual.
One area where Contoura may offer an advantage is in night vision and overall visual quality. By correcting corneal irregularities, topography-guided treatment can reduce higher-order aberrations that cause halos, glare, and starbursts around lights.
Some patients report sharper contrast sensitivity and better vision in low-light conditions after Contoura compared to standard LASIK. However, both procedures have been refined over the years to minimize night vision problems.
Enhancement surgery, also called a touch-up, may be needed if your vision is not fully corrected or if your prescription changes over time. Most practices report low single-digit enhancement rates within the first year, with higher lifetime rates in older patients and those with higher preoperative prescriptions.
Long-term stability is excellent for both LASIK and Contoura when patients are properly selected. Your vision may still change naturally due to aging, especially after age 40 when presbyopia develops, but the correction itself usually remains stable for many years.
Frequently Asked Questions
Contoura generally costs more than standard LASIK because of the advanced technology and additional mapping required. The price difference can range from a few hundred to over a thousand dollars per eye, depending on the practice and your location.
Most health plans consider LASIK and Contoura elective refractive procedures and do not cover them. You can often use a flexible spending account or health savings account to pay with pre-tax dollars.
In the United States, topography-guided Contoura treatment is approved for myopia with or without regular astigmatism. It is not approved for hyperopia.
If you are over 40, you will likely still need reading glasses for close-up tasks because LASIK and Contoura do not correct presbyopia, the age-related loss of near focusing ability. We can discuss monovision or other options if reducing your need for reading glasses is a priority.
Alternatives include PRK for thinner corneas or surface disease, SMILE for certain myopic prescriptions without a corneal flap, phakic ICL for high myopia or thin corneas, and refractive lens exchange in older patients with early lens changes. We will review these with you if they fit your goals.
LASIK may be considered in well-controlled glaucoma with careful monitoring, but it is contraindicated in poorly controlled disease. If you have visually significant cataracts, lens surgery is usually the better option. We coordinate with subspecialists as needed.
Getting Help for Contoura vs. LASIK
Choosing between Contoura and standard LASIK is an important decision that should be based on a thorough evaluation of your eyes and a discussion of your visual goals. Schedule a consultation with our eye doctor to learn which procedure is right for you and to have all your questions answered in person. We will also review whether a non-LASIK alternative would better meet your needs based on your exam and imaging.