LASIK outcomes

Wavefront-guided (WFG) LASIK showed small but measurable advantages in efficacy, predictability, self-reported vision quality and low contrast visual acuity compared with wavefront-optimised (WFO) LASIK, Edward E Manche MD told Refractive Surgery Day at the 2016 American Academy of Ophthalmology Annual Meeting in Chicago. Safety and clinical outcomes were excellent with both procedures, and no difference in induction of higher order aberrations was observed between the two technologies, said Dr Manche, who conducted a series of studies comparing the technologies with colleagues at Stanford University, California, USA. In a prospective, randomised contralateral eye study involving 55 patients, about 84% of eyes treated with WFG LASIK performed with a VISX STAR S4 IR CustomVue® laser (AMO) were within 0.5D of target 12 months after surgery, compared with about 76% of eyes treated with WFO LASIK performed with an Allegretto Wave® Eye-Q 400Hz laser (Alcon), Dr Manche reported. WFG-treated eyes were more likely to achieve 20/20 or better uncorrected visual acuity, and better contrast visual acuity than WFO-treated eyes. Patients preferred the quality of vision in the WFG-treated eye by two-to-one among those who had a preference. WFG outcomes were especially good among patients with low total aberrations, defined as RMS <0.3 microns, before surgery, with statistically better night and day vision clarity, overall vision excellence, and less fluctuating vision. (He L, Manche EE. Am J Ophthamol. 2014;157(6). Kung J, Manche EE. J Refract Surg. 2016 Apr;32(4):230-6) A second prospective, randomised, contralateral eye study involving 36 patients compared WFG and WFO procedures performed on the Allegretto 400Hz system. At 12 months, 94% of WFG-treated eyes were within 0.5D of target compared, with 88% of WFO-treated eyes. More WFG-treated eyes also achieved 20/20 or better vision and had better contrast visual acuity. Patients preferred the WFG-treated vision two-to-one over WFO-treated vision. (Sales CS, Manche EE. Ophthalmology. Dec 2013;120(12):2396-402) A third prospective, randomised, contralateral eye study involving 50 patients compared WFG LASIK performed with the Allegretto laser with WFG-guided LASIK performed with the VISX STAR S4 IR CustomVue laser. At one year, 96% of patients treated with the Allegretto were within 0.5D of target refraction compared with 89% of CustomVue-treated eyes. Allegretto-treated eyes also had significantly better mean night and day vision clarity, Dr Manche said. (Yu CQ, Manche EE. J Cataract Refrct Surg. 2014 Mar;40(3):412-22. Yu CQ, Manche EE. J Refract Surg 2016 Apr;32(4):224-9) “About half of LASIK procedures done in the USA are WFG and half WFO, so it makes sense to compare the two,” Dr Manche said. Larger, multicentre studies are needed to confirm his results, he added. Edward E Manche: lasik.manche@stanford.edu