Wavefront-Guided Versus Wavefront-Optimized Laser in situ Keratomileusis for Patients With Myopia: A Prospective Randomized Contralateral Eye Study

Abstract

To compare the clinical outcomes of wavefront-guided and wavefront-optimized laser in situ keratomileusis (LASIK). Prospective, randomized, fellow-eye-controlled study. The setting was a single academic institution. The study population included 110 eyes of 55 patients with myopia with and without astigmatism. One eye of each patient was randomized to undergo wavefront-guided LASIK by the AMO Visx CustomVue S4 IR excimer laser system; the fellow eye received wavefront-optimized LASIK by the Alcon Allegretto Wave Eye-Q 400 Hz excimer laser system. Corneal flaps were constructed using the Intralase FS 60 Hz femtosecond laser. Patients were followed at postoperative months 1, 3, 6, and 12. The study's main outcome measures were uncorrected visual acuity, stability of refractive correction, contrast sensitivity, and wavefront aberrometry. After 12 months, LASIK eyes had achieved visual acuity of 20/12.5 or better (30 eyes, 56%) in the wavefront-guided group compared to those receiving wavefront-optimized treatment (22 eyes, 41%) (P = 0.016). Average spherical equivalent refractions were -0.13 ± 0.46 diopters in wavefront-guided eyes whereas in wavefront-optimized eyes the refractions were -0.41 ± 0.38 diopters at 12 months. Wavefront-guided eyes also achieved better best-corrected visual acuity at both the 5% and 25% contrast levels (P = 0.022 and P = 0.004, respectively). There were no differences in levels of residual astigmatism (P = 0.798) or in higher order aberrations (P = 0.869). Both wavefront-guided and wavefront-optimized treatments are able to correct myopia safely and effectively in eyes with and without astigmatism. However, wavefront-guided treatment platforms appear to offer significant advantages in terms of residual refractive error, uncorrected distance acuity and contrast sensitivity.