LASIK for Hyperopia, Hyperopic Astigmatism, and Mixed Astigmatism OTA

A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Refractive Surgery Panel: Gary A. Varley, MD; David Huang, MD, PhD; Christopher J. Rapuano, MD, Steven Schallhorn, MD; Brian S. Boxer Wachler, MD; Alan Sugar, MD, MS

Ophthalmology, August 2004, Vol 111, 1604-1617 © 2004 by the American Academy of Ophthalmology. Click here for free access to the OTA.

Reviewed for currency: 2009


Objective: To describe LASIK for hyperopia, hyperopia with astigmatism, and mixed astigmatism and to examine the evidence to answer questions about the safety and efficacy of the procedure.

Methods: A literature search conducted for years 1968 to 2002 retrieved 118 citations. During review and preparation of this article, an additional 2 articles were included. The panel members selected 36 articles for the panel methodologist to review and rate according to the strength of evidence. A level I rating is assigned to properly conducted, well-designed, randomized clinical trials; a level II rating to well-designed cohort and case-control studies; and a level III rating to case series, case reports, and poorly designed prospective and retrospective studies.

Results: This assessment describes 5 nonrandomized interventional trials (level II), 3 nonrandomized comparative trials (level III), and 20 noncomparative case series (level III). Additionally, 6 single-case reports (level III) were included because they reported relevant complications, and 2 theoretical analyses (level III) were als considered. This assessment does not compare studies because many variables such as range of hyperopia, follow-up periods, lasers, microkeratomes, techniques, and surgeon experience have not been controlled.

Conclusions: For low (<3 diopters [D]) to moderate (3-5 D) hyperopia, results from published studies (levels II and III evidence) have shown that LASIK is effective and predictable in achieving very good to excellent uncorrected visual acuity, achieving postoperative refractions within 1 D of emmetropia, and is safe in terms of minimal loss of best-corrected spectacle vision. Although there are fewer data for hyperopic astigmatism, the results available seem to mirror the data for low to moderate hyperopia (levels II and III evidence). The postoperative results for both uncorrected vision and safety are less compelling, as greater amounts of hyperopia are treated (>4 to 5 D). Utilizing hyperopic LASIK for the treatment of consecutive hyperopia and astigmatism is also effective, although the ability to reduce hyperopic astigmatism after radial keratotomy is limited. Although a variety of ablation profiles can be used to treat mixed astigmatism, very good visual results have been reported (levels II and III evidence). Serious adverrse complictions leading to permanent visual loss are possible but, fortunately, very rare. There are insufficient data to compare one laser system with another or one ablation profile with another.