Wavefront-Guided vs Wavefront-Optimized LASIK: A Randomized Clinical Trial Comparing Contralateral Eyes

Abstract

To compare wavefront-guided and wavefront-optimized LASIK in patients with myopic astigmatism up to -7.00 diopters (D) sphere and 3.00 D cylinder. In this prospective, comparative study, 41 patients had wavefront-guided LASIK in one eye and wavefront-optimized LASIK in the fellow eye. The LASIK flap was created with a Hansatome XP microkeratome (Bausch & Lomb). The ALLEGRETTO Concerto excimer laser (WaveLight Laser Technologie AG) was used for photoablation. Pupil centroid shift and cyclotorsion were not compensated in the wavefront-guided treatments. The ALLEGRETTO Wave analyzer was used to measure ocular wavefront aberrations, and the CSV-1000 instrument (VectorVision) was used to measure contrast sensitivity before and 1 and 3 months after LASIK. Preoperative mean spherical equivalent refraction was -4.25±1.19 D (range: -7.50 to -2.50 D) and -4.15±1.21 D (range: -7.13 to -1.75 D) in the wavefront-guided and wavefront-optimized groups, respectively. Three months postoperatively, 33 (89.2%) eyes in the wavefront-guided group and 31 (83.8%) eyes in the wavefront-optimized group had uncorrected distance visual acuity of 20/20. Higher order aberrations increased from 0.28±0.08 μm (range: 0.13 to 0.48 μm) and 0.26±0.08 μm (range: 0.13 to 0.55 μm) to 0.45±0.17 μm (range: 0.18 to 0.71 μm) and 0.45±0.16 μm (range: 0.21 to 0.84 μm) in the wavefront-guided and wavefront-optimized groups, respectively. Except for C6 trefoil (P=.006), all Zernike polynomials increased in both groups postoperatively with no statistical difference between groups in spherical aberration (P=.41), C7 coma (P=.67), C8 coma (P=.79), and trefoil (P=.82). Contrast sensitivity did not decrease in either group and no statistically significant differences between groups were noted. Higher order aberrations, especially spherical aberration, increasd approximately the same amount in both groups.