STAR S4 IR Excimer Laser Research Articles

Wavefront-guided PRK treatment of myopia using a refractive aberrometer.

To evaluate the safety, effectiveness, and patient-reported outcomes of wavefront-guided photorefractive keratectomy (PRK) for the correction of myopic refractive errors with and without astigmatism. U.S. multicenter study. Prospective, nonrandomized clinical investigation. 334 eyes (167 patients) underwent wavefront-guided PRK with the STAR S4 IR Excimer Laser System. Patients had preoperative myopic refractive errors with sphere up to -8.00 diopters (D) and cylinder up to -4.00 D with a maximum spherical equivalent (SE) of -10.00 D. All eyes were targeted for emmetropia, and treatment plans were derived from the iDESIGN system wavefront measurements. At 6 months, the point of refractive stability, 99.4% of eyes achieved 20/20 or better uncorrected distance visual acuity (UDVA), 92% of eyes achieved 20/16 or better UDVA, 85.5% of eyes achieved manifest refraction SE (MRSE) within 0.50 D of target, mean SE was -0.06, and less than 1% of eyes lost more than 2 lines of corrected distance visual acuity. Glare and halos occurred with similar or lower frequencies at 6 months vs preoperative. Results from the National Eye Institute Refractive Error Quality of life questionnaire showed statistically significant improvements at 6 months vs preoperative across most measures of vision-related functioning and well-being. Approximately 98% of patients reported high satisfaction with their overall vision at 6 months. Wavefront-guided PRK with the iDESIGN aberrometer was safe, effective, and predictable for the correction of low to moderate myopia with and without astigmatism and led to high patient satisfaction.

Visual and Refractive Outcomes with a New Topography-integrated Wavefront-guided Lasik Procedure

ABSTRACT Purpose To evaluate the clinical outcomes of laser in situ keratomileusis (LASIK) using a new approach for the calculation of the ablation profile based on wavefront vertexing from pupil plane to corneal. Methods One hundred eyes of 50 patients (age, 21–41 years) with low and moderate myopia were enrolled in this prospective case series. All of them underwent topography-integrated wavefront-guided (TI-WFG) LASIK using the STAR S4IR excimer laser platform (Johnson & Johnson Vision). Visual, refractive, ocular aberrometric, ocular scattering index (OSI) and patient satisfaction outcomes were evaluated after a 90-day follow-up period. Astigmatic changes were evaluated by vector analysis. Results A significant reduction in sphere and cylinder (p < .001) was observed, with a significant improvement in uncorrected (UDVA) and corrected distance visual acuity (CDVA) (p < .001). Postoperative spherical equivalent was within ±0.50 and ±1.00 D in 91.1% (82/90) and 98.9% (89/90) of eyes, respectively. UDVA was 20/20 or better in 98.9% (89/90) of eyes. A total of 50.0% (45/90) of eyes gained 1 line of CDVA. Mean postoperative astigmatic correction index and angle of error were 1.01 ± 0.56 and 0.17 ± 0.18º. Postoperative high-order aberrometric coefficients were below 0.50 μm in 92.2% (83/90) of eyes. Mean postoperative OSI was 0.71 ± 0.44. All patients referred to be satisfied with the final outcomes and would recommend the procedure to their friends and relatives. Conclusions TI-WFG LASIK is a new approach for myopia and myopic astigmatism correction, with preservation of the ocular optical quality and high level of patient satisfaction associated.

Topography/wavefront-guided photorefractive keratectomy combined with crosslinking for the treatment of keratoconus: preliminary results.

To evaluate the clinical outcomes of topography/wavefront-guided (TWFG) photorefractive keratectomy (PRK) using a new high-definition aberrometer combined with epithelium-off crosslinking (CXL-Plus). Centro Oculistico Bresciano, Brescia, Italy. Prospective case series study. Patients with grade I or II keratoconus, according to the Amsler-Krumeich classification, were included in this prospective case series. All cases underwent TWFG PRK using the VISX STAR S4 IR excimer laser and the new iDesign 2.0 system, followed by accelerated epithelium-off CXL. Visual, refractive, ocular aberrometric, and safety outcomes were evaluated during a 6-month follow-up. Thirty-five eyes of 19 patients were included. A significant improvement was observed in the uncorrected and corrected distance visual acuities (P < .001). Manifest sphere and cylinder were reduced significantly (P ≤ .001), with a total of 20 eyes (57%) and 30 eyes (86%) having a postoperative spherical equivalent within ±0.50 and ±1.00 diopter, respectively. Most corneal irregularity indexes and the level of ocular higher-order aberrations, primary coma, and trefoil (P < .05) were significantly reduced postoperatively. No significant corneal haze or safety issues were observed. TWFG PRK, using the iD2 system with simultaneous CXL, regularized the cornea by correcting the spherocylindrical error and minimizing the amount of higher-order aberrations in mild-to-moderate keratoconus.

Vector analysis of astigmatic changes and optical quality outcomes after wavefront-guided laser in situ keratomileusis using a high-resolution aberrometer

To assess the ocular optical quality results as well as theastigmatic changes after wavefront-guided laser insitu keratomileusis (LASIK) in eyes with myopic astigmatism. Instituto Clínico-Quirúrgico Oftalmológico, Bilbao, Vizcaya, Spain. Prospective case series. Thirty-three eyes having wavefront-guided LASIK with the Star S4IR excimer laser combined with the iDesign system were enrolled in the study. Changes in visual acuity, refraction, higher-order aberrations, and ocular scattering index (OSI) were evaluated during a 3-month follow-up. The Alpins method was used to analyze the astigmatic changes. A significant reduction was observed in refraction (P<.001), with significant improvement in uncorrected (UDVA) and corrected (CDVA) distance visual acuities (P<.001). All eyes had a spherical equivalent within ±0.50 diopter (D) and UDVA of 20/25 or better at 90days after surgery. A total of 27.3% of eyes gained lines of CDVA. No significant changes were observed in primary coma and spherical aberration (P≥.551). Likewise, no significant changes were observed in OSI (P=.361), with a mean 90-day postoperative value of 0.66±0.58 (SD). A significant change to negative values of the magnitude of error (P=.007) and a significant decrease in the correction index (P=.004) were observed during the follow-up, with mean 90-day postoperative values of -0.24±0.28 D and 0.86±0.17 D, respectively. Wavefront-guided LASIK using a high-resolution aberrometer provided safe and efficacious correction of myopic astigmatism, with preservation of the ocular optical quality.

Comparative Analysis of the Clinical Outcomes of SMILE and Wavefront-Guided LASIK in Low and Moderate Myopia.

To compare the clinical outcomes of small incision lenticule extraction (SMILE) and wavefront-guided LASIK (WFG LASIK) in eyes with low and moderate myopia. This was a prospective, comparative study enrolling 110 eyes with low and moderate myopia (spherical equivalent ≤ 6.00 diopters [D]). Two groups were differentiated according to the surgical technique used: the WFG LASIK group included 51 eyes (51 patients) undergoing WFG LASIK using the STAR S4IR excimer laser and the iDesign aberrometer (Abbott Medical Optics, Abbott Park, IL) and the SMILE group included 59 eyes (59 patients) undergoing SMILE with the VisuMax platform (Carl Zeiss Meditec, Jena, Germany). Visual, refractive, aberrometric, and contrast sensitivity outcomes were evaluated during a 6-month follow-up. Mean efficacy index was 0.92 ± 0.11 and 1.12 ± 0.17 in the SMILE and WFG LASIK groups, respectively (P < .001). Postoperative spherical equivalent was within ±0.50 D in 81.54% and 98% of eyes in the SMILE and WFG LASIK groups (P < .001), and postoperative cylinder was 0.50 or below in 84.7% and 100% of eyes, respectively (P = .038). Mean safety index was 0.98 ± 0.08 and 1.20 ± 0.14 in the SMILE and WFG LASIK groups (P < .001), with losses of lines of corrected distance visual acuity in 6.8% and 0.0% of eyes, respectively. Higher increase in higher order (P < .001) and coma (P < .001) root mean square and higher decrease in contrast sensitivity for 6, 12, and 18 cycles/degree (P ≤ .001) were observed after SMILE. SMILE and WFG LASIK are efficacious and safe procedures for the correction of low and moderate myopia, but WFG LASIK allows a more predictable outcome and better aberrometric control. [J Refract Surg. 2017;33(5):298-304.].

Femtosecond laser-assisted in situ keratomileusis for the correction of residual ametropia after deep anterior lamellar keratoplasty: a pilot investigation.

PurposeTo evaluate the refractive and visual results of one-stage laser-assisted in situ keratomileusis with femtosecond laser (Femto-LASIK) for the correction of residual ametropia after deep anterior lamellar keratoplasty (DALK).MethodsThis retrospective study included 13 eyes of 12 patients, who underwent corneal Femto-LASIK to correct refractive errors after DALK. IntraLase FS150 was used to create a lamellar flap and excimer laser ablation for refractive correction was performed using the Star S4 IR Excimer Laser in eight cases and the Technolas 217z Excimer Laser in Tissue Saving mode in five cases. Perioperative variables of interest included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction and corneal topography.ResultsThe mean spherical equivalent preoperatively was -4.85±2.82 (range, -9.5 to 0 D). At the last visit the mean postoperative spherical equivalent (SE) was -0.44±0.67 D (P<0.05). The mean postoperative UDVA was 0.12±0.12 logMAR. There was a statistically significant increase in CDVA 6 months after Femto-LASIK (P<0.05). Intraoperative and postoperative complications did not develop in this series of eyes.ConclusionsCorrecting the preoperative manifest refractive error with Femto-LASIK led to a significant improvement in the UDVA and CDVA without surgical complications.

Visual, aberrometric, photic phenomena, and patient satisfaction after myopic wavefront-guided LASIK using a high-resolution aberrometer.

PurposeThe purpose of this study was to evaluate the visual, refractive, and aberrometric outcomes as well as the level of patient satisfaction and photic phenomena after myopic laser in situ keratomileusis (LASIK) surgery using wavefront-guided (WFG) ablations based on measurements obtained with a high-resolution aberrometer.Patients and methodsThis study was a prospective analysis including 253 eyes of 127 patients (aged between 19 years and 54 years) undergoing WFG LASIK using the STAR S4 IR Excimer Laser System combined with the iDesign System and iFS Femtosecond Laser. Visual, refractive, and aberrometric outcomes during a 2-month follow-up as well as patient satisfaction and photic phenomena were evaluated by means of a questionnaire.ResultsA total of 85% (215/253) and 99% (251/253) of eyes achieved a postoperative (Postop) uncorrected distance visual acuity of 20/16 and 20/20, respectively, and all eyes achieved an uncorrected distance visual acuity of 20/25. Postop spherical equivalent values were within ±0.25 D and ±0.50 D in 97% and 100% of eyes, respectively. Likewise, manifest cylinder was <0.25 D in 97% (245/253) of eyes. A statistically significant reduction was found in the total root mean square (P<0.001) and in the level of primary spherical aberration (P=0.001). Postop difficulties related to vision were graded as minimal, with low levels of photic phenomena and high levels of patient satisfaction. The level of difficulty to perform daily activities and the level of glare perceived by patients while driving car were significantly decreased (P<0.001).ConclusionWFG LASIK surgery using the technology evaluated is predictable and effective for the correction of myopia and leads to high levels of patient satisfaction.

Wave Front-Guided Photorefractive Keratectomy Using a High-Resolution Aberrometer After Corneal Collagen Cross-Linking in Keratoconus.

To evaluate the clinical outcomes of wave front-guided (WFG) photorefractive keratectomy (PRK) using a high-definition aberrometer in corneas with keratoconus at least 1 year after corneal collagen cross-linking (CXL). Prospective uncontrolled interventional case series study including a total of 34 consecutive eyes of 25 patients with keratoconus previously treated with CXL. All cases underwent WFG PRK using the VISX STAR S4 IR excimer laser and the iDesign system. All eyes had keratoconus grade I or II according to the Amsler-Krumeich classification. Visual, refractive, and ocular aberrometric outcomes were evaluated during a 12-month follow-up. Astigmatic changes were analyzed with the Alpins vector method. A significant improvement was observed in the uncorrected and corrected distance visual acuities (P < 0.001). The mean efficacy and safety indices at 12 months postoperatively were 1.58 ± 1.11 and 1.96 ± 1.52, respectively. Manifest sphere and cylinder were reduced significantly (P < 0.001), with 76.5% of the eyes having a spherical equivalent within ±1.00 D at 12 months postoperatively. The mean difference vector and magnitude of error were 1.06 ± 0.92 and 0.43 ± 0.86 D, respectively. Some corneal irregularity indices were reduced significantly with surgery (P ≤ 0.005) as well as the level of ocular higher order aberrations, primary coma, and trefoil (P < 0.001). Sequential WFG PRK using the iDesign system and the STAR S4 IR excimer laser after CXL is an effective option to correct the spherocylindrical error and to minimize the level of higher order aberrations in mild and moderate keratoconus if the maximum intended ablation depth does not exceed 15% of the minimal corneal thickness.

Patient-reported outcomes 5 years after laser in situ keratomileusis

To assess vision-related, quality-of-life outcomes 5years after laser in situ keratomileusis (LASIK) and determine factors predictive of patient satisfaction. Optical Express, Glasgow, Scotland. Retrospective case series. Data from patients who had attended a clinical examination 5years after LASIK were analyzed. All treatments were performed using the Visx Star S4 IR excimer laser. Patient-reported satisfaction, the effect of eyesight on various activities, visual phenomena, and ocular discomfort were evaluated 5years postoperatively. Multivariate regression analysis was performed to determine factors affecting patient satisfaction. The study comprised 2530 patients (4937 eyes) who had LASIK. The mean age at the time of surgery was 42.4years±12.5 (SD), and the preoperative manifest spherical equivalent ranged from -11.0 diopters (D) to +4.88 D. Five years postoperatively, 79.3% of eyes were within ±0.50 D of emmetropia and 77.7% of eyes achieved monocular uncorrected distance visual acuity (UDVA) and 90.6% of eyes achieved binocular UDVA of 20/20 or better. Of the patients, 91.0% said they were satisfied with their vision and 94.9% did not wear distance correction. Less than 2.0% of patients noticed visual phenomena, even with spectacle correction. Major predictors of patient satisfaction 5years postoperatively were postoperative binocular UDVA (37.6% variance explained by regression model), visual phenomena (relative contribution of 15.0%), preoperative and postoperative sphere and their interactions (11.6%), and eyesight-related difficulties with various activities such as night driving, outdoor activities, and reading (10.2%). Patient-reported quality-of-life and satisfaction rates remained high 5years after LASIK. Uncorrected vision was the strongest predictor of satisfaction. Dr. S.C. Schallhorn is a consultant to Abbott Medical Optics, Inc., Zeiss Meditec AG, and Autofocus Inc. and a global medical director for Optical Express. No other author has a financial or proprietary interest in any material or method mentioned.

Outcomes of excimer laser enhancements in pseudophakic patients with multifocal intraocular lens.

PurposeThe aim of this study was to assess visual and refractive outcomes of laser vision correction (LVC) to correct residual refraction after multifocal intraocular lens (IOL) implantation.Patients and methodsIn this retrospective study, 782 eyes that underwent LVC to correct unintended ametropia after multifocal IOL implantation were evaluated. Of all multifocal lenses implanted during primary procedure, 98.7% were refractive and 1.3% had a diffractive design. All eyes were treated with VISX STAR S4 IR excimer laser using a convectional ablation profile. Refractive outcomes, visual acuities, patient satisfaction, and quality of life were evaluated at the last available visit.ResultsThe mean time between enhancement and last visit was 6.3±4.4 months. Manifest spherical equivalent changed from −0.02±0.83 D (−3.38 D to +2.25 D) pre-enhancement to 0.00±0.34 D (−1.38 D to +1.25 D) post-enhancement. At the last follow-up, the percentage of eyes within 0.50 D and 1.00 D of emmetropia was 90.4% and 99.5%, respectively. Of all eyes, 74.9% achieved monocular uncorrected distance visual acuity 20/20 or better. The mean corrected distance visual acuity remained the same before (−0.04±0.06 logMAR [logarithm of the minimum angle of resolution]) and after LVC procedure (−0.04±0.07 logMAR; P=0.70). There was a slight improvement in visual phenomena (starburst, halo, glare, ghosting/double vision) following the enhancement. No sight-threatening complications related to LVC occurred in this study.ConclusionLVC in pseudophakic patients with multifocal IOL was safe, effective, and predictable in a large cohort of patients.

Flap lift and photorefractive keratectomy enhancements after primary laser in situ keratomileusis using a wavefront-guided ablation profile: Refractive and visual outcomes

To analyze results of wavefront-guided laser vision correction retreatments performed either by lifting the original flap or by surface ablation over the flap. Optical Express, Glasgow, United Kingdom. Retrospective case series. This retrospective study included patients grouped according to whether they had flap lift enhancement or photorefractive keratectomy (PRK) performed over the LASIK flap. All retreatment procedures were performed with the Visx Star S4 IR excimer laser with wavefront-guided ablation profile derived from the iDesign aberrometer. Visual acuities, refractive outcomes, vector analysis of refractive cylinder and complications were analyzed in this study. The results of the last available clinical visit are presented. This retrospective study included 290 eyes of 202 patients divided into 2 groups: 119 eyes that had flap lift enhancement (Group A), and 171 eyes in which photorefractive keratectomy (PRK) was performed over the LASIK flap (Group B). The mean follow-up was 4.0 ± 1.9 months in Group A and 4.2 ± 1.6 in Group B. The mean postoperative manifest spherical equivalent was -0.01 ± 0.35 D and +0.06 ± 0.39 D in Groups A and B, respectively. The percentage of eyes with postenhancement UDVA 20/20 or better was 87.4% in Group A and 79.5 % in Group B (P = .09). In Group A, 22 eyes (18.5%) developed epithelial ingrowth, of which surgical intervention was required in 2 eyes (1.7%). Grade 1 or less haze was noted in 9 (5.3%) eyes in Group B, and resolved in all cases within the first 6 postoperative months. Both retreatment techniques were considered to be effective, predictable, and safe. Steven C Schallhorn MD is a consultant to Abbott Medical Optics and Zeiss, and Global Medical Director for Optical Express. None of the other authors have a financial or proprietary interest in the products and materials presented in this paper.

Wavefront-Guided Laser Treatment Using a High-Resolution Aberrometer to Measure Irregular Corneas: A Pilot Study.

To evaluate in a pilot study the visual, refractive, corneal topographic, and aberrometric changes after wavefront-guided LASIK or photorefractive keratectomy (PRK) using a high-resolution aberrometer to calculate the treatment for aberrated eyes. Twenty aberrated eyes of 18 patients undergoing wavefront-guided LASIK or PRK using the VISX STARS4IR excimer laser and the iDesign aberrometer (Abbott Medical Optics, Inc., Santa Ana, CA) were enrolled in this prospective study. Three groups were differentiated: keratoconus post-CXL group including 11 keratoconic eyes (10 patients), post-LASIK group including 5 eyes (5 patients) with previous decentered LASIK treatments, and post-RK group including 4 eyes (3 patients) with previous radial keratotomy. Visual, refractive, contrast sensitivity, corneal topographic, and ocular aberrometric changes were evaluated during a 6-month follow-up. An improvement in uncorrected (UDVA) and corrected visual acuity (CDVA) associated with a reduction in the spherical equivalent was observed in the three groups, but was only statistically significant in the keratoconus post-CXL and post-LASIK groups (P ≤ .04). All eyes gained one or more lines of CDVA after surgery. Improvements in contrast sensitivity were observed in the three groups, but they were only statistically significant in the keratoconus post-CXL and post-LASIK groups (P ≤ .04). Regarding aberrations, a reduction was observed in trefoil aberrations in the keratoconus post-CXL group (P = .05) and significant reductions in higher-order and primary coma aberrations in the post-LASIK group (P = .04). Wavefront-guided laser enhancements using the evaluated platform seem to be safe and effective to restore the visual function in aberrated eyes.

Four-Year Visual, Refractive, and Contrast Sensitivity Outcomes After Wavefront-Guided Myopic LASIK Using an Advanced Excimer Laser Platform

To evaluate the 4-year visual, refractive, and contrast sensitivity outcomes of wavefront-guided LASIK for the correction of low to moderate myopia using the VISX CustomVue technology (Abbott Medical Optics, Inc., Santa Ana, CA). This was a prospective study including 255 consecutive eyes of 145 patients (age range: 19 to 55 years) with low to moderate myopia (mean spherical equivalent: -3.36 ± 1.71 diopters [D]) undergoing laser refractive surgery. Wavefront-guided LASIK was performed in all eyes using the VISX STAR S4 IR excimer laser platform and the CustomVue procedure for the ablation profile design. Visual, refractive, and contrast sensitivity changes were evaluated during a 4-year follow-up period. Postoperative logMAR uncorrected distance visual acuity was 0.1 or better (20/25 Snellen) in 98.0% and 100% of eyes at 1 and 4 years, respectively. At 4 years postoperatively, mean spherical equivalent was reduced significantly to a mean value of -0.22 ± 0.28 D (P < .01), with 97.3% of eyes with a spherical equivalent within ±0.50 D. The astigmatic power vector component J0 of manifest refraction was also reduced significantly (P < .01). Postoperative logMAR corrected distance visual acuity was 0.0 or better (20/20 Snellen) in 96.1% and 98.8% of eyes at 1 and 4 years, respectively. Improvement in contrast sensitivity was observed in some spatial frequencies between 1 and 4 years postoperatively. No significant correlations were found between 4-year contrast sensitivity and corrected distance visual acuity (0.024 ≤ r ≤ -0.120, P ≥ .06). Wavefront-guided LASIK using the VISX CustomVue technology provides an effective and predictable correction of low to moderate myopia in the long term, preserving the patient's visual acuity and quality.

Femtosecond Laser–assisted LASIK Improves Quality of Life

To investigate the quality of life (QOL) outcomes of femtosecond laser-assisted LASIK using the Quality of Life Impact of Refractive Correction (QIRC) questionnaire. Translation of the QIRC questionnaire from English to Greek followed standard international protocols. The questionnaire was completed by 190 individuals, aged 18 to 39 years with myopia (range: -0.75 to -8.50 diopters) and corrected distance visual acuity (CDVA) of logMAR 0.2 or better (Snellen equivalent 20/32) in the worse eye. Half of this sample underwent LASIK with femtosecond laser flap creation and ablation with the Visx Star S4 IR excimer laser (Abbott Medical Optics). The questionnaire was scored with Rasch analysis. Validity was tested by internal consistency reliability (Cronbach's α) and repeatability by intraclass correlation coefficient (ICC) and Bland-Altman limits of agreement, convergent validity was examined with inter-item correlations, and construct validity was evaluated by known groups comparison analysis. The total QIRC score improved with femtosecond laser-assisted LASIK from mean 38.9±5.7 preoperatively to 53.7±5.1 postoperatively (P<.001). Among the pre-treatment and control groups, QIRC score was greater for those wearing contact lenses than those wearing spectacles (P<.01). The Greek version of the QIRC had good internal consistency reliability. Inter-item correlations were all significant (P<.001), ranging from 0.32 to 0.79. Repeatability was high (Bland-Altman limits of agreement were -6.72 to +5.41 and ICC for the total score was 0.98). Femtosecond laser-assisted LASIK leads to marked improvements in refractive error-related quality of life. This study also provides evidence for the reliability and validity of the Greek version of the QIRC questionnaire.

Aspheric Wavefront-guided LASIK to Treat Hyperopic Presbyopia: 12-Month Results With the VISX Platform

To evaluate an aspheric ablation profile to improve near vision in presbyopic patients with hyperopia and to outline the key factors of success. A prospective, nonrandomized, clinical trial of 66 eyes of 33 hyperopic patients who underwent customized bilateral refractive surgery, which included an aspheric presbyopia treatment shape and wavefront-driven hyperopic treatment, was studied. Surgeries were performed using the VISX STAR S4 or STAR S4 IR excimer laser system (Abbott Medical Optics). Mean preoperative refractive error was +1.77 ± 0.56 diopters (D) sphere (range: 0.75 to 3.50 D) with 0.41 ± 0.34 D cylinder (range: 0.00 to 1.50 D). All patients received full distance refractive correction. No patients received monovision or were intentionally left with residual myopia. Patient satisfaction results were evaluated using a questionnaire with a 5-point scale. Sixty eyes completed 6-month and 50 eyes completed 12-month postoperative follow-up. At 6 months, mean corrected distance visual acuity (CDVA) was 20/20±1 line (range: 20/25 to 20/10). Mean gain in distance-corrected near visual acuity (DCNVA) was 2.7 ± 1.7 lines with a maximum of 6 lines of near. Spectacle dependence for tasks, such as reading and computer use, was reduced. At 12 months, 100% of patients had achieved binocular simultaneous uncorrected vision of 20/25 or better and J3. Refraction was stable over 12 months. Contrast sensitivity reduction was clinically insignificant (1 step or 0.15 logCS). Negative spherical aberration highly correlated with postoperative improvement of DCNVA. Patients who had a larger amount of preoperative hyperopia or a greater decrease of preoperative DCNVA were more likely to have overall satisfaction. The aspheric ablation designed to expand near functional vision was effective and stable over 12 months. The wavefront-customized hyperopic treatment significantly reduced spectacle dependence.

Wavefront-guided Excimer Laser Vision Correction After Multifocal IOL Implantation

To investigate the use of wavefront-guided LASIK after multifocal intraocular lens (IOL) implantation to correct residual ametropia and higher order aberrations. In a prospective, nonrandomized case series, wavefront-guided LASIK was performed in 27 eyes (19 patients) after multifocal IOL implantation (Tecnis diffractive IOL, n = 20; ReSTOR diffractive IOL, n = 4; ReZoom refractive IOL, n = 3) using the VISX STAR S4 IR excimer laser. Visual acuity, manifest refraction, and wavefront error were examined pre- and 3 months postoperatively. In the Tecnis group, results before (after) LASIK were: sphere +1.06 +/- 0.77 diopters (D) (-0.03 +/- 0.28 D; P = .0001), cylinder -1.13 +/- 0.73 D (-0.14 +/- 0.25 D; P = .00004), distance uncorrected visual acuity (UCVA) 20/45 +/- 0.09 (20/29 +/- 0.16; P = .00004), near UCVA 20/30 +/- 0.24 (20/25 +/- 0.16; P = .001), and higher order aberrations (4-mm pupil) 0.14 +/- 0.05 microm (0.18 +/-0.03 microm; P = .02). Distance and near best spectacle-corrected visual acuity (BSCVA) did not change. In the ReSTOR group, results before (after) LASIK were: sphere +0.75 +/- 0.56 D (+0.13 +/- 0.22 D), cylinder -1.50 +/- 0.47 D (-0.13 +/- 0.22 D), distance UCVA 20/40 +/- 0.07 (20/26 +/- 0.07), near UCVA 20/44 +/- 0.05 (20/25 +/- 0.0), and higher order aberrations (4-mm pupil) 0.14 +/- 0.03 microm (0.20 +/- 0.02 microm). Distance and near BSCVA did not change. In the ReZoom group, results before (after) LASIK were: sphere +0.08 +/- 1.20 D (0.00 D), cylinder -0.83 +/- 0.120 D (0.00 D), distance UCVA 20/40 +/- 0 (20/25 +/- 0), near UCVA 20/60 +/- 0.09 (20/150 +/- 0.18), and higher order aberrations (4-mm pupil) 0.43 +/- 0.04 microm (0.39 +/- 0.03 microm). Patients lost one line of distance BSCVA and two lines of near BSCVA. Wavefront-guided LASIK is safe and effective in diffractive multifocal IOLs to correct residual refractive error, but higher order aberrations did not improve. It is not recommended in refractive multifocal IOLs, as these cannot be measured reliably with current wavefront sensors.