Quality of vision after wavefront-guided laser in situ keratomileusis or photorefractive keratectomy: Contralateral eye evaluation

Subjective visual experience and ocular symptoms after wavefront-guided and wavefront-optimized LASIK in a prospective fellow eye study

PURPOSE

The purpose of this study was to compare the subjective visual experience and ocular symptoms of fellow eyes treated with wavefront-optimized (WFO-) laser-assisted in situ keratomileusis (LASIK) and wavefront-guided (WFG-) LASIK.

DESIGN

Prospective randomized fellow eye, controlled study.

METHODS

Two hundred eyes of 100 subjects from a single academic center were enrolled and randomly assigned to treatment with WFO-LASIK in one eye and WFG-LASIK in the fellow eye. Subjects filled out a validated 14-part questionnaire for each eye at the preoperative visit and at postoperative months 1,3,6,12.

RESULTS

In comparing the number of subjects who reported symptoms in the WFG- vs WFO- LASIK eyes, there was no difference in number reporting any visual experience (glare, halos, starbursts, hazy vision, blurred vision, distortion, double or multiple images, fluctuations in vision, focusing difficulties, and depth perception; all p>0.05) or ocular symptoms (photosensitivity, dry eye, foreign body sensation, ocular pain; all p>0.05). There was no preference for WFG-LASIK (28%) or the WFO-LASIK treated eye (29%) with most subjects reporting no preference (43%; Chi-squared p=0.972). Of the subjects who preferred one eye or the other, the preferred eye saw statistically better than the fellow eye (0.8 ± 1.4 Snellen line, p=0.0002). There was no other difference in subjective visual experience, ocular symptoms, refractive characteristics when taking into account eye preference.

CONCLUSIONS

Most subjects had no eye preference; and for subjects who did have eye preference, the only detectable difference was better visual acuity in the preferred eye.

Patient-Reported Outcomes With Wavefront-Guided Laser in Situ Keratomileusis (PROWL) Study Outcomes From a Single Institution

PURPOSE

To determine patient-reported outcomes after laser in situ keratomileusis (LASIK) using wavefront-guided technology at a single institution.

METHODS

In this prospective observational study, 62 participants underwent examination and questionnaire at baseline, 1 month, and 3 months after surgery. The questionnaire included questions from validated questionnaires and new items to assess patient satisfaction with current vision and LASIK surgery, and existence/degree of visual symptoms.

RESULTS

At month 1, patients reported an improvement in far vision (P = .01), activity limitations (P ≤ .001), and less worry about vision (P ≤ .001), as well as new visual symptoms, including halos (P ≤ .001) and double images (P = .03). At month 3, patients still noted an improvement in near vision (P = .05), far vision (P ≤ .001), activity limitation (P ≤ .001), and worry (P ≤ .001) along with halos (P = .05), double images (P = .01), and dry eye (P = .01). A total of 3.3% of patients at month 1 and 0% at month 3 had difficulty performing any activity due to symptoms, and 34.6% and 25.0% of patients reported decreased quality of life at months 1 and 3, respectively.

CONCLUSIONS

After LASIK, patients experience new visual symptoms. Patients have high rates of satisfaction overall but with some patients reporting a decrease in quality of life 1 month after surgery; quality of life improves by postoperative month 3, with 25% patients reporting a decrease in visual well-being after surgery. [J Refract Surg. 2023;39(3):198-204.].

A Prospective Comparison of Wavefront-Guided LASIK versus Wavefront-Guided PRK After Previous Keratorefractive Surgery

Purpose

To compare the results of retreatment with wavefront-guided LASIK versus wavefront-guided PRK for residual refractive error following previous myopic keratorefractive surgery.

Methods

In this prospective study, 32 eyes of 28 patients after prior myopic keratorefractive surgery underwent retreatment with flap-lift wavefront-guided LASIK (n = 12) or wavefront-guided PRK (n = 20) for residual refractive error. Safety, efficacy, predictability, and wavefront outcomes were evaluated.

Results

At last follow-up, both LASIK and PRK retreatment resulted in similar improvement in visual acuity with respective mean ± standard deviation (SD) uncorrected distance visual acuity of −0.07 ± 0.11 logMAR and −0.06 ± 0.13 logMAR (p = 0.87). In the study, 16.7% of LASIK and 33.3% of PRK eyes gained one or more lines of best-corrected distance visual acuity (CDVA), while 16.7% and 9.5% of eyes lost one or more lines of CDVA with LASIK and PRK, respectively. One hundred % of LASIK eyes and 89.5% of PRK eyes were within ± 0.50 diopters of emmetropia. Wavefront analysis demonstrated similar reductions in total RMS error higher-order aberrations (p = 0.84) with no difference in coma, trefoil, or spherical aberration between eyes undergoing LASIK or PRK retreatment.

Conclusion

Wavefront-guided LASIK and wavefront-guided PRK following previous keratorefractive surgery demonstrate similar safety, efficacy, and predictability with comparable wavefront outcomes.

Contrast Sensitivity After Wavefront-Guided and Wavefront-Optimized PRK and LASIK for Myopia and Myopic Astigmatism

PURPOSE

To compare contrast sensitivity among participants undergoing wavefront-guided or wavefront-optimized photorefractive keratectomy (PRK) or LASIK for the treatment of myopia or myopic astigmatism 12 months after surgery.

METHODS

In a prospective, randomized clinical trial, 215 participants with myopia ranging from -0.50 to -7.25 diopters (D) and less than -3.50 D of manifest astigmatism electing to undergo either LASIK or PRK were randomized to receive wavefront-guided or wavefront-optimized treatment. Corrected Super Vision Test (Precision Vision, La Salle, IL) high contrast and small letter contrast sensitivity, uncorrected postoperative contrast sensitivity function, and uncorrected and corrected distance visual acuity were measured preoperatively and at 1, 3, 6, and 12 months postoperatively.

RESULTS

There was a significant difference within each of the four groups over time when measuring high contrast visual acuity (P < .001) and small letter contrast sensitivity (P < .001), with the most significant decrease occurring 1 month postoperatively. However, there were no significant differences when comparing the four groups for high contrast sensitivity (P = .22) or small letter contrast sensitivity (P = .06). The area under the logarithm of contrast sensitivity function did not differ significantly over time (P = .09) or between groups (P = .16). A pairwise comparison of preoperative to 12-month CDVA showed a significant improvement in all groups (P < .017). The change in CDVA was also significantly different between groups as determined by one-way analysis of variance (P = .003).

CONCLUSIONS

Wavefront-guided and wavefront-optimized PRK and LASIK procedures maintained high contrast, small letter contrast sensitivity, and contrast sensitivity function 12 months postoperatively. Although the recovery period for visual performance was longer for PRK versus LASIK, there was no significant difference in treatment type or treatment profile at 12 months postoperatively. [J Refract Surg. 2018;34(9):590-596.].

Recent advances in wavefront-guided LASIK

PURPOSE OF REVIEW

Laser vision correction remains an active area of research, and there have been many recent advances in the field. The purpose of this review is to provide an update on the recent advances for one of the most common methods of laser vision correction, wavefront-guided laser in-situ keratomileusis (LASIK).

RECENT FINDINGS

Recent technological advancements in wavefront aberrometry are largely responsible for the improved visual outcomes that have been recently reported. In addition, improvements in femtosecond and excimer laser technology, used in flap creation and corneal ablation, have been shown to provide superior results when compared to microkeratomes and earlier lasers. Wavefront-guided LASIK appears to have advantages over some other keratorefractive modalities in terms of visual acuity, predictability, astigmatism correction, and subjective visual symptoms. Nonetheless, there may be some limitations in highly aberrated corneas, and also in biomechanical stability relative to other available platforms.

SUMMARY

Improvements in wavefront aberrometry, and also femtosecond and excimer lasers, have continued to improve our ability to correct refractive errors. Wavefront-guided LASIK remains a well tolerated and effective keratorefractive procedure, with a trend toward superiority. Nonetheless, further studies comparing this modality to others are needed to define the role each can serve.