Cataract surgery is the most performed surgical procedure in the United States, with a phenomenal track record for improving vision. The most common surgical approach creates surgical incisions in the peripheral cornea. Unfortunately, in uncommon cases, these incisions can function as astigmatic keratotomy (AK or RK) incisions and induce irregular astigmatism. This usually leads to a patient that measures well on an eye chart, but is unhappy with their vision.

This irregularity is treated very similarly to an RK repair. The irregularity in the cornea, including the part being compensated for by the epithelium, is treated and decreased. Treatment is in two phases. Phase 1 treats the corneal irregularity and makes a more uniform cornea 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). Phase 2, which typically occurs 4 months later corrects the power of the cornea so full correction is performed. In the interim healing period, the patient can wear simple glasses or contacts to treat the refractive error, but with significantly decreased visual symptoms as the cornea is a much more ideal shape.

In treatment post cataract, usually the first phase allows us to get close enough that the refractive error treated in Phase 2 is not large. Most patients do not use glasses for distance, but may use some for reading while awaiting phase 2.