Wavefront-optimized LASIK Research Articles

Retrospective Study Comparing Topography-Guided and Wavefront-Optimized LASIK Procedures in a Single Center.

To compare visual outcomes of eyes that had laser refractive surgery with the Contoura Phorcides treatment plan and eyes that had laser refractive surgery with the wavefront-optimized treatment plan using the same laser. Retrospective chart review of clinical outcomes of eyes that had either Contoura with Phorcides (CP) or wavefront-optimized (WFO) corneal refractive procedures using the Wavelight EX500 (Alcon Vision, LLC). Data were collected and compared for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refraction, change in postoperative UDVA compared to preoperative CDVA, and change in postoperative CDVA compared to preoperative CDVA. Total eyes included were 348, with 227 in the CP Group and 121 in the WFO Group. Post-operatively, there was a significantly higher percentage of eyes in the CP Group that were 20/16 or better compared to the WFO Group (57%, 129 eyes, and 17%, 21 eyes, respectively; p < 0.001). The percentage of eyes that gained 1 or more Snellen lines of UDVA compared to preoperative CDVA was higher in the CP Group (47%; 107 eyes) compared to the WFO Group (12%; 14 eyes), which was statistically significant (p < 0.001). Differences in refraction were statistically significant. Topography-guided and wavefront-optimized treatment profiles both provided excellent refractive results. A higher percentage of eyes that were treated using Contoura with Phorcides achieved 20/16 or better unaided distance vision compared to eyes receiving a wavefront-optimized treatment plan.

Clinical outcomes of topography-guided versus wavefront-optimized LASIK for correction of myopia and compound myopic astigmatism.

To compare the safety, efficacy, and visual outcomes of topography-guided (TG) LASIK ablation versus advanced ablation algorithm (AAA) on Zeiss Mel 90 on virgin eyes. A tertiary care hospital in north India. A retrospective comparative study. Case sheets of 30 patients who underwent TG LASIK and 45 patients who underwent AAA LASIK between January 2021 and September 2022 were retrieved and reviewed. The TG group included 60 eyes of 30 patients, and the AAA group included age- and sex-matched 90 eyes of 45 patients. Both groups were compared for visual outcomes, residual refraction, and root-mean-square higher-order aberrations (rms HOA) at 1 week, 1 month, 3 months, and 6 months postoperatively and using unpaired t-test and Mann-Whitney U test. The mean preoperative spherical equivalent in the TG group and AAA group was - 3.12 (1.67) and - 3.19 (1.61), respectively. The safety and efficacy of the treatment were 100% in both groups. The postoperative increase in rms HOA was comparable in both groups (P = 0.55). The ablation duration was significantly longer in topo-guided LASIK (P = 0.001). AAA LASIK on MEL 90 is comparable to topography-guided LASIK for the management of low myopia and myopic astigmatism.

Retrospective Analysis of Wavefront-Optimized Myopic LASIK: Comparison of Preoperative to Postoperative Astigmatism and High Order Aberrations: Trefoil and Coma Specifically: Could Topography-Guided Original Customization Had Addressed the Above?

Retrospective Analysis of Wavefront-Optimized Myopic LASIK: Comparison of Preoperative to Postoperative Astigmatism and High Order Aberrations: Trefoil and Coma Specifically: Could Topography-Guided Original Customization Had Addressed the Above?

Comparison of Corneal Optical Quality After SMILE, Wavefront-Optimized LASIK and Topography-Guided LASIK for Myopia and Myopic Astigmatism.

PurposeTo compare visual outcomes and corneal optical quality after small incision lenticule extraction (SMILE), wavefront-optimized (WFO) FS-LASIK, and topography-guided customized ablation treatment (TCAT) FS-LASIK for myopia.MethodsThis prospective case-series study included 283 eyes of 283 myopic patients who underwent SMILE or FS-LASIK. There were 102, 100, and 81 eyes in the SMILE group, WFO group and TCAT group, respectively. The tomography system (Sirius) was used to measure corneal aberrations and optical quality.ResultsAt postoperative 1 and 6 months, there were no significant differences in uncorrected distance visual acuity and corrected distance visual acuity among the three groups (P > 0.05). Postoperative manifest refractive spherical equivalent was similar among the groups (P > 0.05). There was statistically significant difference in cylinder at 1 month among the three groups, with the highest mean value in TCAT group (P < 0.05). The corneal optical path difference, root mean square of corneal astigmatism and strehl ratio were the most superior in the TCAT group at postoperative 1 and 6 months (P < 0.05).ConclusionSMILE, WFO FS-LASIK, and TCAT FS-LASIK provided similar visual results. The corneal visual quality after TCAT FS-LASIK was the best.

Wavefront-guided and Wavefront-optimized LASIK: Visual and Military Task Performance Outcomes.

Wavefront-guided and Wavefront-optimized LASIK: Visual and Military Task Performance Outcomes.

The Impact of Image Registration for Ablation Orientation on Clinical Outcomes After Wavefront-Optimized Refractive Surgery in Eyes with Myopia and Astigmatism.

PurposeTo compare the clinical outcomes from laser refractive surgery performed with the same laser with and without incorporating iris registration technology to compensate for ocular cyclotorsion.DesignSingle-site, two-arm, retrospective chart review.MethodsClinical outcomes at a single site after wavefront-optimized LASIK using the Wavelight excimer laser with and without the Vario imaging system for iris registration (IR) were evaluated. Eligible subjects were those that received on-label wavefront-optimized treatment of myopia with astigmatism >1.5 D. Measures of interest were the amount of residual refractive cylinder after surgery, the refractive error, and the best-corrected (BCVA) and uncorrected (UCVA) visual acuities, with a target follow-up of around 90 days.ResultsA total of 112 eligible eyes that were treated with IR and 126 similar eyes treated without IR (NO IR) were included. The refractive sphere and spherical equivalent refractions were statistically significantly different between groups (p < 0.05), but the mean differences were <0.1 D in both cases. Refractive cylinder averaged around 0.12 D and was not statistically significantly different between groups. The number of eyes with residual cylinder >0.50 D was higher in the NO IR group vs the IR group (6% vs 1%, respectively, p = 0.04). The mean logMAR UCVA and BCVA were statistically significantly better in the IR group, with a difference of 1.5 letters for UCVA and 1.0 letters for BCVA (p < 0.001 for both). Significantly more eyes in the IR group had a UCVA (p = 0.01) and a BCVA of 20/15 or better (p = 0.003). Overall, 96% of eyes in the IR group and 91% of eyes in the NO IR group had uncorrected visual acuity of 20/20 or better.ConclusionIris registration with the VARIO imaging device demonstrably reduced the overall variability in clinical outcomes.

Comparison of outcomes after topography-modified refraction versus wavefront-optimized versus manifest topography-guided LASIK

BackgroundTo compare the outcomes of myopia and myopic astigmatism corrected with topography-modified refraction laser in situ keratomileusis (TMR-LASIK), wavefront-optimized (WFO) LASIK, and topography-guided (TG) LASIK with a correction target based on the manifest refraction (manifest TG-LASIK).MethodsThis observational, retrospective cohort study included patients who underwent LASIK using the WaveLight® EX500 excimer laser to correct myopia and myopic astigmatism between August 2016 and July 2017. Patients who underwent TMR-LASIK (85 patients), WFO-LASIK (70 patients), or manifest TG-LASIK (40 patients) were enrolled, and only one eye from each patient was analyzed. All participants underwent measurement of the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), manifest refraction, vector analysis of astigmatic change, corneal topography, and corneal wavefront analysis at baseline and at every posttreatment visit.ResultsThree months postoperatively, a UDVA of 0.0 logMAR or better and manifest refraction spherical equivalent (MRSE) within ±0.5 diopters (D) did not differ across the TMR-, WFO-, and manifest TG-LASIK groups. However, the residual cylinder in the TMR group was significantly larger than that in the WFO and manifest TG groups. The magnitude of error in the TMR group measured using astigmatism vector analysis was significantly higher than that in the WFO and manifest TG groups.ConclusionsAlthough these three LASIK platforms achieved the predicted surgical outcomes, TMR-LASIK overcorrected astigmatism and showed a higher residual postoperative astigmatism compared with WFO- and manifest TG-LASIK.

Astigmatic Outcomes after Wavefront-Guided and Wavefront-Optimized Refractive Surgeries for Myopia with Low to Moderate Cylinder

Purpose: To compare the efficacy and accuracy of wavefront-guided (WFG) and wavefront-optimized (WFO) PRK and LASIK for the treatment of myopia with low to moderate astigmatism.Methods: In this prospective cohort study, 215 active duty military service members (430 eyes, mean spherical equivalent -3.61 ± 1.53 D) electing either PRK or LASIK were randomized to undergo WFG or WFO treatment. Up to 12 months, postoperative visual outcomes following surgeries were compared between 4 treatment groups: WFG PRK, WFG LASIK, WFO PRK, and WFO LASIK for myopia with 0.25 to 0.50 D astigmatism (≤ 0.50 D cyl subgroup) and ≥ 0.75 D astigmatism (≥ 0.75 D cyl subgroup). High and low contrast visual acuities were assessed and vector analysis was performed.Results: At 12 months postoperatively, the surgically induced astigmatism, magnitude of error, correction and flattening indices were significantly different between treatment groups (P values ≤ 0.001) in the ≤ 0.50 D cyl subgroup. In ≥ the 0.75 D cyl subgroup, there were no significant differences in vector analysis parameters except for the magnitude of error and correction index (P values ≤ 0.010). The treatment groups were comparable in terms of postoperative uncorrected distance visual acuity, manifest spherical equivalent, and best-corrected low contrast visual acuity.Conclusions: No treatment modality showed consistent superiority in correcting low to moderate astigmatism. Overall, both PRK and LASIK using either wavefront-guided or wavefront-optimized laser platforms were similarly effective and accurate in treating myopia with a low to moderate amount of astigmatism.

Control of Induced Spherical Aberration in Moderate Hyperopic LASIK by Customizing Corneal Asphericity.

To compare differences in induced aberrations and visual acuity after wavefront-optimized LASIK and aspheric-customized LASIK for the treatment of hyperopia. Forty consecutive eyes underwent uneventful LASIK for treatment of moderate hyperopia (+3.82 ± 0.63 diopters [D] [+2.75; +5.125]). A standard procedure was performed in the wavefront-optimized LASIK group (n = 24), whereas a postoperative Q-factor equal to zero was scheduled in the aspheric-customized LASIK group (n = 16). At 6 months, mean spherical aberration for a 6-mm pupil diameter was -0.39 ± 0.23 µm (range: -0.76 to 0.01 µm) and Q-factor was -0.52 ± 0.22 (range: -1.00 to -0.12 µm) in the wavefront-optimized group and 0.04 ± 0.18 µm (range: -0.34 to 0.29 µm) and -0.04 ± 0.25 (range: -0.64 to 0.40 µm) in the aspheric-customized LASIK group (P ≤ .05). All remaining outcomes showed no significant differences between groups. UDVA was 20/18.69 ± 0.15 (range: 0.80 to 1.20) in the wavefront-optimized LASIK group and 20/20 ± 0.17 (range: 0.50 to 1.20) in the aspheric-customized LASIK group. One patient in the wavefront-optimized LASIK group lost two or more lines of CDVA and no lines were lost in the aspheric-customized LASIK group. The results in this small cases series suggest that using an aspheric-customized ablation profile with a target Q-factor equal to 0 in moderate hyperopic LASIK is statistically compatible with a diminishing induced spherical aberration without altering procedural safety when the WaveLight Allegretto 400-Hz excimer laser platform (Alcon Laboratories, Inc., Fort Worth, TX) is used.

One-Year Outcomes from a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized LASIK in Myopes

To compare wavefront (WF)-guided and WF-optimized LASIK in myopes. Prospective, randomized, eye-to-eye study. A total of 72 eyes of 36 participants with myopia with or without astigmatism. Participants were randomized to receive WF-guided or WF-optimized LASIK with the WaveLight Allegretto Eye-Q 400-Hz excimer laser platform (Alcon, Inc., Hüenberg, Switzerland). LASIK flaps were created using the 150-kHz IntraLase iFS (Abbott Medical Optics, Santa Ana, CA). Evaluations included measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), <5% and <25% contrast sensitivity, and WF aberrometry. Patients also completed a validated questionnaire detailing symptoms on a quantitative scale. Safety, efficacy, predictability, refractive error, UDVA, CDVA, contrast sensitivity, and higher-order aberrations (HOAs). The frequency with which the WF-guided and WF-optimized groups achieved postoperative UDVA of ≥ 20/16 or ≥ 20/20 and the frequency with which the groups lost 1 or 2 or more lines or maintained their preoperative CDVA were not statistically different from each other (all P > 0.05). The frequency with which the WF-guided group attained a refractive error within ± 0.25 diopters of emmetropia was higher than in the WF-optimized group (67.6%, 95% confidence interval [CI], 50.4-84.8 vs. 41.2%, 95% CI, 23.2-59.2; P = 0.03). The WF-guided group's mean UDVA was better than the WF-optimized group's UDVA by approximately 1 Early Treatment Diabetic Retinopathy Study line (-0.17 ± 0.11 logarithm of the minimum angle of resolution [logMAR], slightly <20/12 Snellen vs. -0.13 ± 0.12, slightly >20/16; P = 0.05). There were no statistically significant differences in contrast sensitivity, astigmatism, coma, or higher-order root mean square error between the groups (all P > 0.05), but the WF-guided group had less trefoil compared with the WF-optimized group (0.14 ± 0.07 vs. 0.20 ± 0.09; P < 0.01). There were no statistically significant differences in subjective parameters between the groups (all P > 0.05). Wavefront-guided and WF-optimized LASIK using the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform provide similar results in myopic patients; however, the WF-guided approach may yield small gains in visual acuity, predictability, and HOAs.

Corneal Higher Order Aberrations After Myopic Wavefront-optimized Ablation

To analyze the induced corneal higher order aberrations (HOAs) after wavefront-optimized ablation. Sixty-four myopic eyes that underwent wavefront-optimized myopic LASIK were divided into three groups based on spherical equivalent (SE): low myopia group (23 eyes with SE <-3.00 diopters [D]); moderate myopia group (27 eyes with SE between -3.00 and -6.00 D); and high myopia group (14 eyes with SE >-6.00 D). Total corneal HOA, corneal spherical aberrations, corneal coma through a 6-mm pupil size, and corneal eccentricity were measured with a dual Scheimpflug imaging device preoperatively and 3 months after surgery. An overall increase in total corneal HOA was observed with a mean of 0.18±0.18 μm (P<.01), although this induction was not statistically significant in the low myopic group with a mean of 0.006±0.15 μm (P=.85). Root-mean-square spherical aberration varied the most after myopic ablation, with an overall induction of positive spherical aberration of 0.27±0.25 μm (P<.001). Although the wavefront-optimized profile was designed to preserve the preoperative HOAs of the total eye, a significant induction of the corneal HOAs after myopic treatment was observed. The magnitude of the induced corneal HOA was related to the amount of intended correction. Corneal wavefront profiles do not reflect the visual performance; however, they provide relevant information, which may help in optimizing new laser treatment algorithms.

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

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.

Comparing Conventional and Wavefront-optimized LASIK for the Treatment of Hyperopia

To compare differences in visual outcomes and induced spherical aberration after conventional and wavefront-optimized LASIK for the treatment of hyperopia. In a prospective, randomized, single-center clinical trial, 51 consecutive eyes underwent LASIK for the treatment of hyperopia. Eyes were divided between groups treated with conventional LASIK with the Alcon LADAR4000 excimer laser (n=25) and wavefront-optimized LASIK with the WaveLight ALLEGRETTO excimer laser (n=26). Refractive and visual outcomes, induced spherical aberrations, and contrast sensitivity were analyzed. On postoperative day 1, 20% of eyes treated with a conventional profile had uncorrected visual acuity (UCVA) of 20/20 or better compared to 65% of eyes receiving wavefront-optimized treatment (P=.0011). By 6 months, UCVA was 20/20 or better in 72% and 84% of the conventional and wavefront-optimized treatment groups, respectively (P=.3254). At 6 months, the manifest refraction spherical equivalent was -0.21+/-0.47 diopters (D) and 0.16+/-0.27 D (P=.6469) whereas the cylinder was -0.41+/-0.47 D and -0.17+/-0.27 D (P=.0332) for the conventional and wavefront-optimized treatment groups, respectively. Induced spherical aberration was -0.54+/-0.32 microm and -0.42+/-0.21 microm for the conventional and wavefront-optimized treatment groups, respectively (P=.1195). The respective change in mesopic and photopic area under the log contrast sensitivity function was -0.05+/-0.29 and -0.05+/-0.23 for the conventional treatment group and 0.08+/-0.39 and 0.08+/-0.41 for the wavefront-optimized treatment group (P=.1970). Wavefront-optimized (ALLEGRETTO) and conventional (LADAR4000) ablation predictably and safely correct low to moderate hyperopia. Wavefront-optimized ablation showed superior results with regards to rapid visual recovery and residual cylinder. Although not statistically significant, a trend towards less induced negative spherical aberrations and improved mesopic and photopic contrast sensitivity was noted with wavefront-optimized treatment.

Incidence, Outcomes, and Risk Factors for Retreatment After Wavefront-optimized Ablations With PRK and LASIK

To analyze and compare retreatment rates after wavefront-optimized photorefractive keratectomy (PRK) and LASIK and determine risk factors for retreatment. A retrospective chart review was performed to identify patients undergoing PRK or LASIK with the wavefront-optimized WaveLight platform from January 2005 through December 2006 targeted for a piano outcome and to determine the rate and risk factors for retreatment surgery in this population. Eight hundred fifty-five eyes were analyzed, including 70 (8.2%) eyes with hyperopic refractions and 785 (91.8%) eyes with myopic refractions. After initial treatment, 72% of eyes were 20/20 or better and 99.5% were 20/40 or better. To improve uncorrected visual acuity, 54 (6.3%) eyes had retreatments performed. No significant differences in retreatment rates were noted based on age (P = .15), sex (P = .8), eye (P = .3), PRK versus LASIK (P = 1.0), room temperature (P = .1) or humidity (P = .9), and no correlation between retreatment rate and month or season of primary surgery (P = .4). There was no correlation between degree of myopia and retreatment rate. Eyes were significantly more likely to undergo retreatment if they were hyperopic (12.8% vs 6.0%, P = .006) or had astigmatism > or = 1.00 diopter (D) (9.1% vs 5.3%, P = .04). Retreatment rate was 6.3% with the WaveLight ALLEGRETTO WAVE excimer laser. This rate was not influenced by age, sex, corneal characteristics, or environmental factors. Eyes with hyperopic refractions or astigmatism > or = 1.00 D were more likely to undergo retreatment.

Wavefront-optimized Versus Wavefront-guided LASIK for Myopic Astigmatism With the ALLEGRETTO WAVE: Three-month Results of a Prospective FDA Trial

To compare visual outcomes using the WaveLight ALLEGRETTO WAVE to administer either wavefront-optimized (standard LASIK) or wavefront-guided (custom LASIK) treatments in myopic eyes. In this prospective, open-label, multicenter study conducted in the United States, 374 eyes were randomized by alternating enrollment to receive either wavefront-optimized or wavefront-guided LASIK treatments with this laser platform. Bilateral treatments were administered, with both eyes of each patient receiving the same treatment. Corneal flaps were created using the IntraLase femtosecond laser. In this FDA clinical trial, results at 3 months postoperatively revealed that 93% of eyes in both cohorts receiving either wavefront-optimized or wavefront-guided treatments attained an uncorrected visual acuity (UCVA) of 20/20 or better. Seventy-six percent of eyes with the wavefront-optimized treatment and 64% of eyes with the wavefront-guided treatment achieved UCVA of 20/16 or better. None of the eyes that received either treatment lost two lines or more of best spectacle-corrected visual acuity (BSCVA). In addition, 58% of eyes with wavefront-optimized treatment and 62% of eyes with wavefront-guided treatment gained one line or more of BSCVA. None of the eyes in either treatment group underwent retreatment. In the majority of eyes, no statistically significant differences were found between either treatment group in regard to visual acuity and refractive outcomes. Wavefront-guided treatments are not required in most cases with this laser, but may be considered if the magnitude of preoperative root-mean-square (RMS) higher order aberrations is >0.35 microm. In this study population, 83% of eyes had preoperative RMS higher order aberrations of <0.3 microm.

Higher Order Aberrations After LASIK for Myopia With Alcon and WaveLight Lasers: A Prospective Randomized Trial

To evaluate the differences in higher order aberration outcomes between bilateral wavefront-guided and wavefront-optimized LASIK treatments on two closely matched patient groups 1 and 3 months following surgery. Thirty patients were enrolled in the study and randomly assigned to undergo bilateral LASIK with either the Alcon CustomCornea laser system or the WaveLight Allegretto Wave laser system. Standard clinical outcomes such as visual acuity and manifest refraction were evaluated as well as quality of vision measures such as subjective questionnaires and higher order aberrations. All patients completed follow-up examinations for 3 months following surgery. At 1 and 3 months after surgery, the uncorrected visual acuity and the refractive outcome were similar for the two laser platforms, with 90% to 93% eyes being within +/- 0.5 D of intended outcome. At 1 and 3 months the Alcon CustomCornea group had a statistically significant lower amount of induced total higher order aberrations compared to the Allegretto Wave group (P < .05). LASIK for myopia with the Alcon CustomCornea and WaveLight Allegretto Wave systems is highly effective in terms of refractive outcome and uncorrected visual acuity. However, aberrations were statistically significantly greater after treatment with the WaveLight Allegretto Wave system than with the Alcon CustomCornea.