2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 5: Photoablation: Techniques and Outcomes
Wavefront-Guided, Wavefront-Optimized, and Topography-Guided Treatment Outcomes for Myopia and Hyperopia
Wavefront-guided or wavefront-optimized LASIK coupled with sophisticated eye-tracking systems has greatly improved the accuracy and reproducibility of results, allowing even higher percentages of patients to obtain UCVA of 20/20 and 20/40. In wavefront-guided LASIK for myopic astigmatism, for example, up to about –10.00 to –12.00 D, 79%–95% of patients obtained 20/20 UCVA, and 96%–100% obtained 20/40 UCVA. In wavefront-guided LASIK for hyperopic astigmatism up to +6.00 D, 55%–59% of patients obtained 20/20 UCVA, and 93%–97% obtained 20/40 UCVA. In wavefront-guided LASIK for mixed astigmatism with up to +5.00 D of cylinder, 56%–61% of patients obtained 20/20 UCVA, and 95% obtained 20/40 UCVA. A recent study found that the visual acuity results for the vast majority of patients were equivalent between wavefront-guided and wavefront-optimized LASIK.
Recent clinical trial data on topography-guided ablations demonstrated that for corrections up to –9.00 D of spherical equivalent myopia with up to –8.00 D spherical and –3.00 D astigmatic components, 93% of eyes had UCVA of 20/20 or better. The data also demonstrated that 32% of eyes achieved 20/12.5 or better and 69% achieved 20/16 or better. In 30% of patients, postoperative UCVA improved 1 line or more compared to preoperative BCVA.
Fares U, Otri AM, Al-Aqaba MA, Faraj L, Dua HS. Wavefront-optimized excimer laser in situ keratomileusis for myopia and myopic astigmatism: refractive outcomes and corneal densitometry. J Cataract Refract Surg. 2012;38(12):2131–2138.
Keir NJ, Simpson T, Jones LW, Fonn D. Wavefront-guided LASIK for myopia: effect on visual acuity, contrast sensitivity, and higher order aberrations. J Refract Surg. 2009;25(6): 524–533.
Randleman JB, Perez-Straziota CE, Hu MH, White AJ, Loft ES, Stulting RD. Higher-order aberrations after wavefront-optimized photorefractive keratectomy and laser in situ keratomileusis. J Cataract Refract Surg. 2009;35(2):260–264.
Schallhorn SC, Farjo AA, Huang D, et al; American Academy of Ophthalmology. Wavefrontguided LASIK for the correction of primary myopia and astigmatism: a report by the American Academy of Ophthalmology. Ophthalmology. 2008;115(7):1249–1261.
Tan J, Simon D, Mrochen M, Por YM. Clinical results of topography-based customized ablations for myopia and myopic astigmatism. J Refract Surg. 2012;28(Suppl 11):S829–S836.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.