Over the last several years, the FDA has approved many indications for WFG LASIK on a variety of laser platforms. Hyperopia, mixed astigmatism, as well as myopia with astigmatism are now approved (Table 1). A review of the 6-month data for the treatment of low-to-moderate myopia reported to the FDA for both wavefront-guided and conventional treatment clearly shows an improvement in effectiveness of the wavefront results. This applies to all laser systems currently approved for custom treatment. While conventional treatments met the FDA criteria for uncorrected acuity and intended versus achieved acuity, WFG outcomes were much better (Table 2).
Higher-order aberrations (HOAs) can reduce visual performance in normal individuals when the pupil is dilated, such as can occur at night. While conventional LASIK can effectively reduce sphere and cylinder (lower-order aberrations), it significantly increases HOAs. Patients who have subjective complaints and irregular corneas following LASIK can have 2.3 to 3.5 times more HOAs than those who are asymptomatic and have normal corneas. While results vary with laser platform and refractive error, current WFG LASIK generally increases the amount of HOAs in eyes with low preoperative levels. However, WFG LASIK can predictably reduce HOAs in eyes with high preoperative levels. Regardless of the preoperative level, WFG LASIK induces significantly fewer HOAs than conventional LASIK. This key advantage of WFG LASIK has been shown to reduce disabling quality-of-vision symptoms compared to conventional treatment. While each laser manufacturer reports symptoms slightly differently, it is clear that frequency and severity of symptoms are less after WFG LASIK (Table 3). Studies have also shown that WFG LASIK may be an effective form of re-treatment following conventional surgery. In these cases, WFG LASIK can effectively reduce HOAs.