A New Night Vision Disturbances Parameter and Contrast Sensitivity as Indicators of Success in Wavefront-guided Enhancement

Abstract

To determine the level of success of wavefront-guided repair of night vision disturbances after conventional (Munnerlyn) myopic LASIK using a new parameter to describe higher order aberrations, and to compare the improvements to matched myopic LASIK controls who were symptom-free. We developed a single parameter metric to represent raw spherical aberration (RAWS) to functionally describe the cumulative spherical aberration for an eye over a range of physiological pupil sizes. To derive the RAWS parameter, spherical aberration is plotted over pupil analysis zones from 3000 to 6000 microm. The RAWS parameter (unit = microm2) is then equal to the area under the plot. Sixteen eyes treated for night vision disturbances by wavefront-guided repair were each compared to the mean of four matched control eyes (total 64 eyes) treated by aspheric myopic ablation and without night vision disturbances. Contrast sensitivity and RAWs parameter for spherical aberration were determined for each of the repair eyes and control eyes before and after surgery. Following wavefront-guided repair, 76% of eyes were subjectively reported to have night vision disturbances improved by at least 80%. The percentage of eyes within normal contrast range increased from 25% to 80% following wavefront-guided repair (P < .05). For the control eyes, LASIK increased RAWS by 126% (RAWS was 122 microm2 preoperatively and 276 microm2 postoperatively). For the night vision disturbances repair eye group, RAWS at presentation was 104% (563 microm2) above the respective postoperative RAWS control eyes. Following wavefront-guided repair, RAWS was decreased (P < .05) to only 49% (410 microm2) above the postoperative control group. The RAWS parameter enabled a single digit descriptor of overall higher order aberrations for an eye over the principal physiological pupil range. By comparing RAWS parameter changes in wavefront-guided repair eyes to matched postoperative asymptomatic eyes, we were able to determine the magnitude of the deficit in the symptomatic eyes and the relative efficacy of wavefront-guided repair.