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Moshfeghi S, Razmjou H, Peyman A, Kateb H, Naderan M. A comparison between wavefront-optimized and wavefront-guided photorefractive keratectomy in patients with moderate-to-high astigmatism: A randomized clinical trial. J Curr Ophthalmol 2022; 34:194-199. [PMID: 36147260 PMCID: PMC9487005 DOI: 10.4103/joco.joco_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose: Methods: Results: Conclusion:
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Li SM, Kang MT, Wang NL, Abariga SA. Wavefront excimer laser refractive surgery for adults with refractive errors. Cochrane Database Syst Rev 2020; 12:CD012687. [PMID: 33336797 PMCID: PMC8094180 DOI: 10.1002/14651858.cd012687.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Refractive errors (conditions in which the eye fails to focus objects accurately on the retina due to defects in the refractive system), are the most common cause of visual impairment. Myopia, hyperopia, and astigmatism are low-order aberrations, usually corrected with spectacles, contact lenses, or conventional refractive surgery. Higher-order aberrations (HOAs) can be quantified with wavefront aberration instruments and corrected using wavefront-guided or wavefront-optimized laser surgery. Wavefront-guided ablations are based on preoperative measurements of HOAs; wavefront-optimized ablations are designed to minimize induction of new HOAs while preserving naturally occurring aberrations. Two wavefront procedures are expected to produce better visual acuity than conventional procedures. OBJECTIVES The primary objective was to compare effectiveness and safety of wavefront procedures, laser-assisted in-situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) or laser epithelial keratomileusis (LASEK) versus corresponding conventional procedures, for correcting refractive errors in adults for postoperative uncorrected visual acuity, residual refractive errors, and residual HOAs. The secondary objective was to compare two wavefront procedures. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; 2019, Issue 8); Ovid MEDLINE; Ovid Embase; Latin American and Caribbean Health Sciences (LILACS); the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 6 August 2019. We imposed no restrictions by language or year of publication. We used the Science Citation Index (September 2013) and searched the reference lists of included trials to identify additional relevant trials. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing either wavefront modified with conventional refractive surgery or wavefront-optimized with wavefront-guided refractive surgery in participants aged ⪰ 18 years with refractive errors. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. MAIN RESULTS We identified 33 RCTs conducted in Asia, Europe and United States, totaling 1499 participants (2797 eyes). Participants had refractive errors ranging from high myopia to low hyperopia. Studies reported at least one of the following review-specific outcomes based on proportions of eyes: with uncorrected visual acuity (UCVA) of 20/20 or better, without loss of one or more lines of best spectacle-corrected visual acuity (BSCVA), within ± 0.50 diopters (D) of target refraction, with HOAs and adverse events. Study characteristics and risk of bias Participants were mostly women, mean age 29 and 53 years, and without previous refractive surgery, ocular pathology or systemic comorbidity. We could not judge risks of bias for most domains of most studies. Most studies in which both eyes of a participant were analyzed failed to account for correlations between two eyes in the analysis and reporting of outcomes. Findings For the primary comparison between wavefront (PRK or LASIK or LASEK) and corresponding conventional procedures, 12-month outcome data were available from only one study of PRK with 70 participants. No evidence of more favorable outcomes of wavefront PRK on proportion of eyes: with UCVA of 20/20 or better (risk ratio [RR] 1.03, 95% confidence interval (CI) 0.86 to 1.24); without loss of one or more lines of BSCVA (RR 0.94, 95% CI 0.81 to 1.09); within ± 0.5 D of target refraction (RR 1.03, 95% CI 0.86 to 1.24); and mean spherical equivalent (mean difference [MD] 0.04, 95% CI -0.11 to 0.18). The evidence for each effect estimate was of low certainty. No study reported HOAs at 12 months. At six months, the findings of two to eight studies showed that overall effect estimates and estimates by subgroup of PRK or LASIK or LASEK were consistent with those for PRK at 12 month, and suggest no difference in all outcomes. The certainty of evidence for each outcome was low. For the comparison between wavefront-optimized and wavefront-guided procedures at 12 months, the overall effect estimates for proportion of eyes: with UCVA of 20/20 or better (RR 1.00, 95% CI 0.99 to 1.02; 5 studies, 618 participants); without loss of one or more lines of BSCVA (RR 0.99, 95% CI 0.96 to 1.02; I2 = 0%; 5 studies, 622 participants); within ± 0.5 diopters of target refraction (RR 1.02, 95% CI 0.95 to 1.09; I2 = 33%; 4 studies, 480 participants) and mean HOAs (MD 0.03, 95% CI -0.01 to 0.07; I2 = 41%; 5 studies, 622 participants) showed no evidence of a difference between the two groups. Owing to substantial heterogeneity, we did not calculate an overall effect estimate for mean spherical equivalent at 12 months, but point estimates consistently suggested no difference between wavefront-optimized PRK versus wavefront-guided PRK. However, wavefront-optimized LASIK compared with wavefront-guided LASIK may improve mean spherical equivalent (MD -0.14 D, 95% CI -0.19 to -0.09; 4 studies, 472 participants). All effect estimates were of low certainty of evidence. At six months, the results were consistent with those at 12 months based on two to six studies. The findings suggest no difference between two wavefront procedures for any of the outcomes assessed, except for the subgroup of wavefront-optimized LASIK which showed probable improvement in mean spherical equivalent (MD -0.12 D, 95% CI -0.19 to -0.05; I2 = 0%; 3 studies, 280 participants; low certainty of evidence) relative to wavefront-guided LASIK. We found a single study comparing wavefront-guided LASIK versus wavefront-guided PRK at six and 12 months. At both time points, effect estimates consistently supported no difference between two procedures. The certain of evidence was very low for all estimates. Adverse events Significant visual loss or optical side effects that were reported were similar between groups. AUTHORS' CONCLUSIONS This review suggests that at 12 months and six months postoperatively, there was no important difference between wavefront versus conventional refractive surgery or between wavefront-optimized versus wavefront-guided surgery in the clinical outcomes analyzed. The low certainty of the cumulative evidence reported to date suggests that further randomized comparisons of these surgical approaches would provide more precise estimates of effects but are unlikely to modify our conclusions. Future trials may elect to focus on participant-reported outcomes such as satisfaction with vision before and after surgery and effects of remaining visual aberrations, in addition to contrast sensitivity and clinical outcomes analyzed in this review.
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Affiliation(s)
- Shi-Ming Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Meng-Tian Kang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Ning-Li Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China
| | - Samuel A Abariga
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
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Akondi V, Dubra A. Average gradient of Zernike polynomials over polygons. OPTICS EXPRESS 2020; 28:18876-18886. [PMID: 32672177 PMCID: PMC7340383 DOI: 10.1364/oe.393223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/03/2020] [Accepted: 05/25/2020] [Indexed: 05/23/2023]
Abstract
Wavefront estimation from slope sensor data is often achieved by fitting measured slopes with Zernike polynomial derivatives averaged over the sampling subapertures. Here we discuss how the calculation of these average derivatives can be reduced to one-dimensional integrals of the Zernike polynomials, rather than their derivatives, along the perimeter of each subaperture. We then use this result to derive closed-form expressions for the average Zernike polynomial derivatives over polygonal areas, only requiring evaluation of polynomials at the polygon vertices. Finally, these expressions are applied to simulated Shack-Hartmann wavefront sensors with 7 and 23 fully illuminated lenslets across a circular pupil, with their accuracy and calculation time compared against commonly used integration methods.
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Jun I, Kang DSY, Tan J, Choi JY, Heo W, Kim JY, Lee MG, Kim EK, Seo KY, Kim TI. Comparison of clinical outcomes between wavefront-optimized versus corneal wavefront-guided transepithelial photorefractive keratectomy for myopic astigmatism. J Cataract Refract Surg 2019; 43:174-182. [PMID: 28366363 DOI: 10.1016/j.jcrs.2016.11.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate and compare the clinical outcomes, including visual acuity, refractive errors, and aberrations, between aberration-free transepithelial photorefractive keratectomy (PRK) and corneal wavefront-guided transepithelial PRK in eyes with myopic astigmatism. SETTING Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN Retrospective comparative case series. METHODS Patients with myopic astigmatism were treated with aberration-free transepithelial PRK or corneal wavefront-guided transepithelial PRK using a 1050 Hz high-repetition excimer laser. The safety, efficacy, predictability, and corneal aberrations were compared preoperatively and 1, 2, 3, and 6 months postoperatively. RESULTS The study comprised 188 patients (188 eyes); 91 eyes had aberration-free transepithelial PRK and 97 eyes corneal wavefront-guided transepithelial PRK. Six month after surgery, the mean uncorrected distance visual acuity was comparable (-0.06 logMAR ± 0.07 [SD] aberration-free group; -0.06 ± 0.06 logMAR wavefront-guided group). The safety, efficacy, and predictability of refractive and visual outcomes were also comparable between groups. Corneal total root-mean-square (RMS) higher-order aberrations (HOAs) increased after treatment in both groups, although fewer RMS HOAs were induced in the corneal wavefront-guided group than in the aberration-free group. Spherical aberration increased similarly after treatment in both groups. However, coma and trefoil increased only in the aberration-free group. CONCLUSIONS Aberration-free transepithelial PRK and corneal wavefront-guided transepithelial PRK were safe and effective for correction of myopic astigmatism without difference in visual acuity and refractive outcomes. However, the corneal wavefront-guided profile induced fewer corneal aberrations than the aberration-free profile.
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Affiliation(s)
- Ikhyun Jun
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - David Sung Yong Kang
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Jerry Tan
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Jin Young Choi
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Woon Heo
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Joo Young Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Min Goo Lee
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Eung Kweon Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Kyoung Yul Seo
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore
| | - Tae-Im Kim
- From the Institute of Vision Research (Jun, E.K. Kim, Seo, T-i. Kim), the Corneal Dystrophy Research Institute (Jun, E.K. Kim, T-i. Kim), Department of Ophthalmology, the Department of Pharmacology (Jun, Heo, J.Y. Kim, Lee), Brain Korea 21 PLUS Project for Medical Sciences, Severance Biomedical Science Institute, Yonsei University College of Medicine, and the Eyereum Eye Clinic (Kang, Choi), Seoul, South Korea; the Jerry Tan Eye Surgery (Tan), Singapore.
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Kim TI, Alió Del Barrio JL, Wilkins M, Cochener B, Ang M. Refractive surgery. Lancet 2019; 393:2085-2098. [PMID: 31106754 DOI: 10.1016/s0140-6736(18)33209-4] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/29/2018] [Accepted: 12/11/2018] [Indexed: 01/19/2023]
Abstract
Refractive surgery has evolved beyond laser refractive techniques over the past decade. Laser refractive surgery procedures (such as laser in-situ keratomileusis), surface ablation techniques (such as laser epithelial keratomileusis), and photorefractive keratectomy have now been established as fairly safe procedures that produce excellent visual outcomes for patients with low-to-moderate amounts of ametropia. Additionally, a broader selection of options are now available to treat a wider range of refractive errors. Small incision lenticule extraction uses a femtosecond laser to shape a refractive lenticule, which is removed through a small wound. The potential advantages of this procedure include greater tectonic strength and less dry eye. In the future, intracorneal implants could be used to treat hyperopia or presbyopia. Phakic intraocular implants and refractive lens exchange might be useful options in carefully selected patients for correcting high degrees of ametropia. Thus, physicians are now able to provide patients with the appropriate refractive corrective option based on the individual's risk-benefit profile.
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Affiliation(s)
- Tae-Im Kim
- Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, South Korea
| | - Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Research & Development Department VISSUM Innovation Alicante, Alicante, Spain; Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Mark Wilkins
- Department of Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Beatrice Cochener
- Department of Ophthalmology, University Hospital Morvan, Brest, France
| | - Marcus Ang
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore.
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Comparison between Wavefront-optimized and corneal Wavefront-guided Transepithelial photorefractive keratectomy in moderate to high astigmatism. BMC Ophthalmol 2018; 18:154. [PMID: 29940974 PMCID: PMC6020237 DOI: 10.1186/s12886-018-0827-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 06/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the clinical outcomes of wavefront-optimized (WFO) transepithelial photorefractive keratectomy (trans-PRK) and corneal wavefront-guided (CWFG) trans-PRK for myopic eyes with moderate to high astigmatism. METHODS One hundred ninety-six eyes (196 patients) with moderate to high astigmatism (≥ 1.75 D) treated with WFO or CWFG trans-PRK (101 and 95 eyes, respectively) were retrospectively registered. Safety, efficacy, predictability, vector analysis, and corneal aberrations were compared between groups preoperatively and at 6 months postoperatively. RESULTS At postoperative 6 months, the mean logMAR uncorrected distance visual acuity was similar in the WFO (- 0.07 ± 0.08) and CWFG (- 0.07 ± 0.07) groups. Safety, efficacy, and predictability of refractive and visual outcomes were also similar. The correction indices were 1.02 ± 0.14 and 1.03 ± 0.13 in the WFO and CWFG groups, respectively, with no significant difference. The absolute values of the angle of error were significantly higher in the WFO group (2.28 ± 2.44 vs. 1.40 ± 1.40; P = 0.002). Corneal total root mean square higher-order aberrations and corneal spherical aberrations increased postoperatively in both groups; however, the change was smaller in the CWFG group. Corneal coma showed a significant increase postoperatively only in the WFO group. CONCLUSIONS WFO and CWFG trans-PRK are safe and effective for correcting moderate to high astigmatism. However, CWFG trans-PRK provides a more predictable astigmatism correction axis and fewer induced corneal aberrations.
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Kobashi H, Kamiya K, Igarashi A, Takahashi M, Shimizu K. Two-years results of small-incision lenticule extraction and wavefront-guided laser in situ keratomileusis for Myopia. Acta Ophthalmol 2018. [PMID: 28631305 DOI: 10.1111/aos.13470] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the 2-years visual and refractive outcomes between small-incision lenticule extraction (SMILE) and wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopia and myopic astigmatism. METHODS Our retrospective case-control study examined 30 eyes of 30 patients with the manifest refraction spherical equivalent (MRSE) of -3.71 ± 1.83 dioptres (D) who underwent SMILE and 30 eyes of 30 patients with MRSE of -3.81 ± 1.40 D who underwent wavefront-guided LASIK. We assessed the 2-years clinical outcomes. RESULTS Logarithm of the minimal angle of resolution (LogMAR)-corrected distance visual acuity (CDVA) was -0.23 ± 0.07 in the SMILE group and -0.24 ± 0.07 in the wavefront-guided LASIK group 2 years postoperatively (p = 0.82). Logarithm of the minimal angle of resolution-uncorrected distance visual acuity (UDVA) was -0.18 ± 0.09 and -0.15 ± 0.11 (p = 0.30, respectively). In the SMILE and wavefront-guided LASIK groups 2 years postoperatively, 100% and 73% of eyes, respectively, were within 0.5 D of the prompted MRSE correction (p = 0.005). Changes in the MRSE of -0.10 ± 0.30 D and -0.23 ± 0.51 D occurred from 3 months to 2 years (p = 0.40, respectively). We found a significant correlation between myopic regression and the changes in the keratometric readings from 3 months to 2 years after wavefront-guided LASIK (r = -0.48, p = 0.002), but not after SMILE (r = -0.004, p = 0.90). CONCLUSION Small-incision lenticule extraction offers better refractive outcomes than wavefront-guided LASIK during a 2-years follow-up for the correction of myopia and myopic astigmatism.
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Affiliation(s)
- Hidenaga Kobashi
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Kazutaka Kamiya
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Akihito Igarashi
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Masahide Takahashi
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
| | - Kimiya Shimizu
- Department of Ophthalmology; University of Kitasato School of Medicine; Kanagawa Japan
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Refractive Errors & Refractive Surgery Preferred Practice Pattern®. Ophthalmology 2018; 125:P1-P104. [DOI: 10.1016/j.ophtha.2017.10.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/02/2017] [Indexed: 11/19/2022] Open
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Lee JJ, Kim MK, Wee WR. Effect of Iris registration on visual outcome in wavefront-guided LASEK for myopic astigmatism. Int Ophthalmol 2017; 38:513-525. [PMID: 28285388 DOI: 10.1007/s10792-017-0486-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/04/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to investigate the effect of iris registration (IR) on visual outcomes in wavefront-guided LASEK for myopic astigmatism. METHODS The retrospective chart review was performed for wavefront-guided LASEK using VISX Star S4 in patients with myopic astigmatism (cylinder ≥ 1.00 diopter[D]). Eyes were divided into IR group (LASEK with IR at the time of surgery) and Non-IR group (LASEK without IR system + failed-IR engagement during LASEK). Visual acuity (VA), astigmatism, higher-order aberration (HOA), and contrast sensitivity were assessed preoperatively and 3 months postoperatively. The IR and Non-IR groups were subcategorized depending on the spherical equivalent (lower myopia ≤-5.00 D vs. higher myopia >-5.00 D) for the comparison of HOA changes. RESULTS Postoperative uncorrected VAs showed no differences between IR (n = 30) and Non-IR (n = 46). In astigmatic vector analyses, no differences were noted in the mean magnitude of error and the mean angle of error between two groups. There were no differences in postoperative total HOA, spherical aberration (SA), coma, and trefoil between the groups, either. The total HOA and SA increased in both groups, while coma increased only in Non-IR. In higher myopia, ΔRMS of coma was smaller in IR. Preoperative and postoperative total HOA were linearly correlated in Non-IR, but not for IR. Contrast sensitivity of 12 cycles per degree improved in both groups. CONCLUSION IR had similar outcomes to conventional trackers in wavefront-guided LASEK, with less tendency of inducing coma, especially in higher myopia.
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Affiliation(s)
- Jong Joo Lee
- Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
| | - Won Ryang Wee
- Department of Ophthalmology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
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Jung JW, Chung BH, Han SH, Kim EK, Seo KY, Kim TI. Comparison of Measurements and Clinical Outcomes After Wavefront-Guided LASEK Between iDesign and WaveScan. J Refract Surg 2015; 31:398-405. [PMID: 26046707 DOI: 10.3928/1081597x-20150521-06] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/15/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare the measurements of refractive errors and ocular aberrations obtained using iDesign and WaveScan (Abbott Medical Optics, Inc., Santa Ana, CA), and to compare surgical outcomes of wavefront-guided LASEK using ablation profiles based on both aberrometers. METHODS Ninety myopic eyes of 45 normal patients were evaluated using both the iDesign and WaveScan to measure spherical and cylindrical errors, spherical equivalents, and Zernike coefficients of ocular aberrations. Wavefront-guided LASEK was performed in a different group of 59 eyes of 30 patients divided into two groups, the iDesign and Wavescan groups. The clinical outcomes between the two groups including uncorrected visual acuity, refractive errors, contrast sensitivity, and ocular aberration were compared at 1, 3, and 6 months postoperatively. RESULTS The iDesign produced significantly higher myopic values for refractive errors than the WaveScan, as well as significantly lower levels of total higher order, third, fourth, and fifth order root mean square values and Zernike coefficients of vertical coma and spherical aberration. At postoperative 1, 3, and 6 months, there were no statistically significant differences between the two groups in terms of uncorrected visual acuity and remaining refractive errors. The percentages of patients with spherical equivalents within ±1.00 and ±0.50 diopters of emmetropia were 100% (29 eyes) and 75.9% (22 eyes), respectively, in the iDesign group and 96.7% (29 eyes) and 70.0% (21 eyes), respectively, in the WaveScan group. Mesopic contrast sensitivity values were significantly higher, and the change in root mean square values for spherical aberration was significantly lower in the iDesign group. CONCLUSIONS There were significant differences between the iDesign and the WaveScan in the measurements of refraction and ocular aberrations. Wavefront-guided LASEK based on an ablation profile from the iDesign demonstrated comparable refractive predictability with the WaveScan group, resulting in minimal physician adjustment and superior postoperative visual quality.
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Ali MA, Kobashi H, Kamiya K, Igarashi A, Miyake T, Elewa MEM, Komatsu M, Shimizu K. Comparison of astigmatic correction after femtosecond lenticule extraction and wavefront-guided LASIK for myopic astigmatism. J Refract Surg 2014; 30:806-11. [PMID: 25437478 DOI: 10.3928/1081597x-20141113-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 09/15/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare postoperative astigmatic correction between femtosecond lenticule extraction (FLEx) and wavefront-guided LASIK in eyes with myopic astigmatism. METHODS Fifty-eight eyes of 41 patients undergoing FLEx and 49 eyes of 29 patients undergoing wavefront-guided LASIK to correct myopic astigmatism were examined. Visual acuity, cylindrical refraction, predictability of the astigmatic correction, and astigmatic vector components were compared between groups 6 months after surgery. RESULTS There was no statistically significant difference in manifest cylindrical refraction (P = .08) or percentage of eyes within ± 0.50 diopter (D) of its refraction (P = .11) between the surgical procedures. The index of success in FLEx was statistically significantly better than that of wavefront-guided LASIK (P = .02), although there was no significant difference between the groups in other indices (eg, surgically induced astigmatism, target-induced astigmatism, astigmatic correction index, angle of error, difference vector, and flattening index). Subgroup analysis showed that FLEx had a better index of success (P = .02) and difference vector (P = .04) than wavefront-guided LASIK in the low cylinder subgroup; the angle of error in FLEx was significantly smaller than that of wavefront-guided LASIK in the moderate cylinder subgroup (P = .03). CONCLUSIONS Both FLEx and wavefront-guided LASIK worked well for the correction of myopic astigmatism by the 6-month follow-up visit. Although FLEx had a better index of success than wavefront-guided LASIK when using vector analysis, it appears equivalent to wavefront-guided LASIK in terms of visual acuity and the correction of astigmatism.
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Wu J, Zhong X, Yang B, Wang Z, Yu K. Combined wavefront-guided laser in situ keratomileusis and aspheric ablation profile with iris registration to correct myopia. J Cataract Refract Surg 2013; 39:1059-65. [PMID: 23809945 DOI: 10.1016/j.jcrs.2013.01.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 01/24/2013] [Accepted: 01/24/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To compare the effects of a combined wavefront-guided and aspheric ablation profile with an aspheric ablation profile alone to correct myopia in patients with a preoperative total higher-order aberration root mean square (HOA RMS) lower than 0.30 μm in both eyes. SETTING Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China. DESIGN Comparative case series. METHODS Laser in situ keratomileusis was performed, with 1 eye randomized to wavefront-guided with aspheric ablation and the fellow eye to aspheric ablation only. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest subjective refraction, corneal topography, RMS value of total and grouped HOAs, and contrast sensitivity were measured preoperatively and 1 and 6 months postoperatively. RESULTS The study enrolled 62 eyes (31 patients). The increasing factors of total HOA RMS, 3rd-order RMS and 4th-order RMS were 2.09, 2.09, and 1.99, respectively, in the wavefront-guided with aspheric ablation group and 2.52, 2.68, and 2.51, respectively, in the aspheric ablation only group at 6 months; the aspheric ablation group had statistically significantly larger increasing factors (P=.016, P=.038, and P=.027, respectively). The reduction in contrast sensitivity log values was statistically significantly less in the wavefront-guided with aspheric ablation group than in the aspheric ablation only group except at 1.5 cycles per degree. CONCLUSION The wavefront-guided with aspheric ablation profile was associated with better limitation of HOAs and faster recovery of mesopic contrast sensitivity for patients with a preoperative total HOA RMS lower than 0.30 μm. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Junshu Wu
- Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology, Hainan Eye Hospital, Sun Yat-sen University, Guangzhou, China
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Kamiya K, Shimizu K, Igarashi A, Kobashi H, Komatsu M. Comparison of visual acuity, higher-order aberrations and corneal asphericity after refractive lenticule extraction and wavefront-guided laser-assisted in situ keratomileusis for myopia. Br J Ophthalmol 2012; 97:968-75. [DOI: 10.1136/bjophthalmol-2012-302047] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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López-Miguel A, Maldonado MJ, Belzunce A, Barrio-Barrio J, Coco-Martín MB, Nieto JC. Precision of a commercial hartmann-shack aberrometer: limits of total wavefront laser vision correction. Am J Ophthalmol 2012; 154:799-807.e5. [PMID: 22902046 DOI: 10.1016/j.ajo.2012.04.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 04/26/2012] [Accepted: 04/26/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the intrasession and intersession precision of higher-order aberrations (HOAs) measured using a commercial Hartmann-Shack wavefront sensor (Zywave; Bausch & Lomb) in refractive surgery candidates. DESIGN Prospective, experimental study of a device. METHODS To analyze intrasession repeatability, 1 experienced examiner measured 30 healthy eyes 5 times successively. To study intersession reproducibility, the same clinician obtained measurements from another 30 eyes in 2 consecutive sessions at the same time of day 1 week apart. RESULTS For intrasession repeatability, excellent intraclass correlation coefficients (ICCs) were obtained for total ocular aberrations, total HOAs, and second-order terms (ICC, > 0.94). The ICCs for third-order terms also were high (ICCs, > 0.87); however, fourth-order ICCs varied from 0.71 to 0.90 (Z(4)(0) = 0.90); and fifth-order ICCs were less than 0.85. For intersession reproducibility, only total ocular aberrations, total ocular HOAs, second-order terms, Z(4)(0), Z(3)(1), and Z(3-)(3) had ICCs of 0.90 or more. Bland-Altman analysis showed that the limits of agreement (were clinically too wide for most higher-order Zernike terms, especially for the third-order terms (> 0.21 μm). CONCLUSIONS Total ocular aberrations, total HOAs, and second-order terms can be measured reliably by Zywave aberrometry without anatomic recognition. Third-order terms and Z(4)(0) are repeatable, but not as reproducible between visits. Fourth-order terms, except for Z(4)(0), and fifth-order terms are not sufficiently reliable for clinical decision making or treatment. Because the variability of Zywave can be a major limitation of a truly successful wavefront-guided excimer laser procedure, surgeons should consider treating HOA magnitudes that are more than the intrasession repeatability values (2.77 × S(w)) as those presented in this study.
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Mello GR, Rocha KM, Santhiago MR, Smadja D, Krueger RR. Applications of wavefront technology. J Cataract Refract Surg 2012; 38:1671-83. [DOI: 10.1016/j.jcrs.2012.07.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/27/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
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Visual performance after posterior chamber phakic intraocular lens implantation and wavefront-guided laser in situ keratomileusis for low to moderate myopia. Am J Ophthalmol 2012; 153:1178-86.e1. [PMID: 22365084 DOI: 10.1016/j.ajo.2011.12.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 12/09/2011] [Accepted: 12/09/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare postoperative visual function after implantable collamer lens (ICL) implantation and after wavefront-guided laser in situ keratomileusis (LASIK) in eyes with low to moderate myopia. DESIGN Retrospective observational case study. PATIENTS AND METHODS We investigated 30 eyes of 20 patients undergoing ICL implantation and 64 eyes of 38 patients undergoing wavefront-guided LASIK for the correction of low to moderate myopia (manifest spherical equivalent: -3.00 to -5.88 diopters [D]). Ocular higher-order aberrations (HOAs) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry and a contrast sensitivity unit before and 3 months after surgery, respectively. From the contrast sensitivity, the area under the log contrast sensitivity function was calculated. RESULTS For 4-mm and 6-mm pupils, the changes in ocular third-order aberrations, fourth-order aberrations, and total HOAs after ICL implantation were significantly less than those after wavefront-guided LASIK (P < .05, Mann-Whitney U test). The postoperative area under the log contrast sensitivity function was significantly increased after ICL implantation (P < .001), whereas, after wavefront-guided LASIK, it was not significantly changed (P = .11). CONCLUSIONS ICL implantation induces significantly fewer ocular HOAs than wavefront-guided LASIK. Moreover, CS was significantly improved after ICL implantation but unchanged after wavefront-guided LASIK in eyes with low to moderate myopia. Thus, even in the correction of low to moderate myopia, ICL implantation appears to be superior in visual performance to wavefront-guided LASIK, suggesting that it may be a viable surgical option for the treatment of such eyes.
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Smadja D, Reggiani-Mello G, Santhiago MR, Krueger RR. Wavefront ablation profiles in refractive surgery: description, results, and limitations. J Refract Surg 2012; 28:224-32. [PMID: 22373035 DOI: 10.3928/1081597x-20120217-01] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Accepted: 12/06/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To provide an overview of the clinical results of different ablation profiles based on wavefront technology and discuss their characteristics and limitations. METHODS Literature review of studies reporting results of ablation profiles based on wavefront technology in virgin healthy eyes. RESULTS Over the past 10 years, a large number of studies comparing different treatment algorithms and newer excimer laser platforms have been published. Thirty-six clinical studies including 3637 eyes analyzing the clinical results obtained after wavefront-guided, wavefront-optimized, and Q-factor profiles have been reviewed. Although wavefront-driven profiles allowed reduction of the amount of induced optical aberrations with conventional ablations, thereby improving the quality of vision, it appears that no algorithm of treatment or excimer laser platform has demonstrated a clear superiority over another. Wound healing and unexpected biomechanical response to surgery affect the accuracy of customized treatments and produce variable results. In addition, it is difficult to rigorously analyze and compare findings among different studies because of the diverse variety in which the data are reported. CONCLUSIONS Despite several technological improvements over the years, wavefront ablation profiles have not consistently demonstrated superiority in terms of visual acuity and lower order aberrations compared to the standard procedure, although the induction of higher order aberrations has been reduced. The concept of an individualized eye model has emerged recently, based on the optical ray tracing algorithm, and could theoretically provide a higher level of customization, thus fulfilling the promise of "super vision."
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Affiliation(s)
- David Smadja
- Refractive Surgery Department, Cole Eye Institute, Cleveland Clinic Foundation, Ohio, USA.
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D'Arcy F, Kirwan C, Qasem Q, O'Keefe M. Prospective contralateral eye study to compare conventional and wavefront-guided laser in situ keratomileusis. Acta Ophthalmol 2012; 90:76-80. [PMID: 20074288 DOI: 10.1111/j.1755-3768.2009.01845.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare outcomes of customized/wavefront guided with conventional ablation in myopic patients with or without astigmatism undergoing laser in situ keratomileusis. METHODS A prospective, comparative, contralateral eye study was performed. Sixty-eight eyes of 34 myopic patients with similar refractive error in both eyes were included. One eye was randomly selected to undergo conventional and the fellow eye customized ablation. Surgery was performed using the Technolas 217z laser (Bausch & Lomb, Surrey, UK). Uncorrected visual acuity, manifest refractive spherical equivalent (MRSE), astigmatism, aberrometry and contrast sensitivity were recorded pre and 3 months postoperatively. RESULTS Mean MRSE treated in the conventional and customized groups were 3.77 ± 1.61 dioptres and -3.83 ± 1.59 dioptres respectively. Three months postoperatively there was no significant difference between the groups in mean MRSE (p = 0.99) or cylinder (p = 0.56). The factor increase in postoperative total higher order aberrations (HOAs) was less in the customized (1.32) compared with the conventional (1.54) treatment group but did not reach statistical significance (p = 0.08). Scotopic contrast sensitivity decreased significantly postoperatively in the conventional but not in the customized treatment group. CONCLUSION Visual acuity and refractive error outcomes were similar in both treatment group and no patient preference was observed. Customized ablation was associated with a smaller but not statistically significant postoperative increase in HOAs, better preservation of scotopic contrast sensitivity, quicker treatment time and removal of less corneal tissue.
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Affiliation(s)
- Fiona D'Arcy
- Mater Private Hospital, Eccles Street, Dublin 7, Ireland
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Smadja D, Reggiani-Mello G, Touboul D, Colin J. Les profils de photoablation cornéenne en chirurgie réfractive. Partie 1 : la quête de l’excellence. J Fr Ophtalmol 2012; 35:126-35. [DOI: 10.1016/j.jfo.2011.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 08/30/2011] [Accepted: 09/02/2011] [Indexed: 10/14/2022]
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Mifflin MD, Hatch BB, Sikder S, Bell J, Kurz CJ, Moshirfar M. Custom vs conventional PRK: a prospective, randomized, contralateral eye comparison of postoperative visual function. J Refract Surg 2012; 28:127-32. [PMID: 22230057 DOI: 10.3928/1081597x-20120103-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 11/28/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine whether VISX S4 (VISX Inc) custom photorefractive keratectomy (PRK) results in better visual outcomes than VISX S4 conventional PRK. METHODS Photorefractive keratectomy was performed on 80 eyes from 40 patients in this randomized, prospective, contralateral eye study. Dominant eyes were randomized to one group with the fellow eye receiving the alternate treatment. Primary outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, and root-mean-square (RMS) higher order aberrations. RESULTS Mean UDVA was -0.023±0.099 (20/19) in the custom group and -0.044±0.080 (20/18) in the conventional group 6 months after surgery (P=.293). Mean CDVA was -0.073±0.067 (20/17) in the custom group and -0.079±0.071 (20/17) in the conventional group 6 months after surgery (P=.659). Total higher order aberration RMS and spherical aberration increased in both groups compared to preoperative values (P<.05). Coma increased in the conventional group (P<.05) whereas it was similar to preoperative values in the custom group. No significant differences were noted in induction of trefoil. CONCLUSIONS Custom and conventional PRK were shown to be safe and effective with excellent visual acuity and contrast sensitivity performance at 6 and 12 months. Conventional PRK induced more coma than custom PRK; however, this did not seem to correlate with clinical outcomes.
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Affiliation(s)
- Mark D Mifflin
- University of Utah, Department of Ophthalmology and Visual Sciences, Salt Lake City, Utah, USA.
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Wavefront analysis and Zernike polynomial decomposition for evaluation of corneal optical quality. J Cataract Refract Surg 2011; 38:343-56. [PMID: 22176886 DOI: 10.1016/j.jcrs.2011.11.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 09/09/2011] [Accepted: 10/07/2011] [Indexed: 11/20/2022]
Abstract
Wavefront-guided excimer laser refractive surgery and new customized intraocular lens and contact lens designs are major clinical applications of corneal wavefront analysis. Other therapeutic applications include corneal disorders, conventional excimer laser refractive surgery, incisional techniques and cataract surgery, corneal transplantation, intrastromal corneal ring segment implantation, and crosslinking therapy. Basic data regarding corneal wavefront aberrations, such as distribution in the population and changes with aging, are essential for understanding the nature of each aberration and correcting it. Corneal aberrometry also improved our comprehension of the optical effects of the aforementioned topics while helping us assess the success of the procedures. Zernike polynomials are representations of the higher- and lower-order aberrations of the cornea, allowing a mathematical approach to their determination. Polynomials are used to model individual components of the wavefront in familiar terms. This article reviews the current knowledge of the wavefront aberrations of the human cornea and analyzes studies in the fields of anterior segment surgery and/or therapy, diseases, and optical quality in the context of this knowledge.
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Fares U, Suleman H, Al-Aqaba MA, Otri AM, Said DG, Dua HS. Efficacy, predictability, and safety of wavefront-guided refractive laser treatment: metaanalysis. J Cataract Refract Surg 2011; 37:1465-75. [PMID: 21782089 DOI: 10.1016/j.jcrs.2011.02.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 02/23/2011] [Accepted: 02/26/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the efficacy, predictability, safety, and induced higher-order aberrations (HOAs) between wavefront-guided and non-wavefront-guided ablations. SETTING Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, United Kingdom. DESIGN Metaanalysis. METHODS The Cochrane Central Register of Controlled Trials, PubMED, and EMBASE were searched for randomized controlled trails. Trials meeting the selection criteria were quality appraised and data extracted by 2 independent authors. Measures of association were pooled quantitatively using metaanalytical methods. Comparison between wavefront-guided and non-wavefront-guided ablations was measured as pooled odds ratios (ORs) or weighted mean differences. The pooled ORs and 95% confidence intervals (CIs) were computed for efficacy, safety, and predictability. The weighted mean difference and 95% CIs were used to compare induced HOAs. RESULTS Eight trials involving 955 eyes were included. After wavefront-guided LASIK, the pooled OR of achieving uncorrected distance visual acuity (UDVA) of 20/20 (efficacy) was 1.10 (95% CI, 0.66-1.83; P=.72), the pooled OR of achieving a result within ± 0.50 diopter of intended target (predictability) was 1.03 (95% CI, 0.60-1.75; P=.92), and the weighted mean difference in induced HOAs was -0.09 (95% CI, -0.17 to -0.01; P=.04). No study reported loss of 2 or more lines of Snellen acuity (safety) with either modality. CONCLUSIONS Metaanalysis showed no clear evidence of a benefit of wavefront-guided over non-wavefront-guided ablations. However, there was a lack of standardized reporting of UDVA better than 20/20, which might mask an advantage in wavefront-guided treatment. With high preexisting HOAs, wavefront-guided has advantages over non-wavefront-guided treatment.
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Affiliation(s)
- Usama Fares
- Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, United Kingdom
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Kamiya K, Umeda K, Igarashi A, Ando W, Shimizu K. Factors influencing the changes in coma-like aberrations after myopic laser in situ keratomileusis. Curr Eye Res 2011; 36:905-9. [PMID: 21950695 DOI: 10.3109/02713683.2011.593729] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To assess factors affecting changes in coma-like aberrations after myopic laser in situ keratomileusis (LASIK). METHODS We retrospectively examined 91 eyes of 48 patients undergoing LASIK (mean patient age ± standard deviation, 29.6 ± 8.1 years; gender, 29 male and 19 female; manifest refraction, -4.76 ± 1.42 diopters). We quantitatively assessed the values of coma-like aberrations for 4-mm and 6-mm pupils using a Hartmann-Shack aberrometer before and 3 months after surgery. Multiple regression analysis was used to assess the relevant factors of the changes in coma-like aberrations. RESULTS The mean changes in coma-like aberrations for 4-mm and 6-mm pupils were 0.08 ± 0.09 μm and 0.31 ± 0.30 μm, respectively. Explanatory variables relevant to the changes in coma-like aberrations were, in order of influence, amount of spherical equivalent correction (partial regression coefficient B = 0.022, p <0.001 for a 4-mm pupil, B = 0.090, p <0.001 for a 6-mm pupil), and surgical technique (B = -0.062, p = 0.01 for a 4-mm pupil, B = -0.169, p = 0.03 for a 6-mm pupil). No significant correlation was seen with other clinical factors such as age, gender, astigmatism correction, mean keratometric readings, central corneal thickness, or eye tracking (with or without). CONCLUSIONS High myopic eyes requiring larger amounts of laser correction and eyes undergoing conventional LASIK tend to induce more coma-like aberration after surgery. Wavefront-guided LASIK may be a better surgical approach for preventing the induction of coma-like aberrations, especially in eyes with high myopia.
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Affiliation(s)
- Kazutaka Kamiya
- Department of Ophthalmology, University of Kitasato School of Medicine, Sagamihara, Kanagawa, Japan.
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El Awady HE, Ghanem AA, Saleh SM. Wavefront-optimized ablation versus topography-guided customized ablation in myopic LASIK: comparative study of higher order aberrations. Ophthalmic Surg Lasers Imaging Retina 2011; 42:314-20. [PMID: 21534496 DOI: 10.3928/15428877-20110421-01] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Accepted: 03/24/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare the outcomes of wavefront-optimized ablation and topography-guided ablation in fellow eyes of patients undergoing laser in situ keratomileusis (LASIK) for myopia. PATIENTS AND METHODS This prospective study included 84 patients who underwent LASIK in both eyes: wavefront-optimized ablation in one eye (group I) and topography-guided ablation in the fellow eye (group II). The Moria2 microkeratome with a 110 single-use head (Moria, Antony, France) was used to create a superior hinged flap and the Allegretto Wave Excimer Laser (Alcon/Wavelight Light Laser Technologie GmbH, Erlangen, Germany) for photoablation. The Allegretto wave analyzer was used to measure the ocular aberrations before and 6 months after LASIK. Refractive visual outcomes and ocular aberration changes were compared between the two treatment modalities. RESULTS Six months postoperatively, the mean uncorrected visual acuity of group II was statistically better than that of group I (P = .02). Seventy percent of group I and 83% of group II achieved a postoperative spherical equivalent refraction of ±0.5 diopters. The postoperative total root-mean-square of higher order aberrations (HOAs) of group II was smaller than that of group I, but the difference was not statistically significant (P = .51). There was a decrease in most of the individual terms of HOAs in group II, but it was only statistically significant in Z(3) (-1) (P = .04). The reverse occurred in group I, where most of the individual terms of HOAs increased, but it was not statistically significant. Significant improvement was only noted in Z(5) (3) (P = .05) and Z(5) (5) (P = .04). CONCLUSION Both wavefront-optimized ablation and topography-guided ablation provided good refractive results, but the latter induced fewer HOAs.
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Affiliation(s)
- Hatem E El Awady
- Ophthalmology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Miraftab M, Seyedian MA, Hashemi H. Wavefront-Guided vs Wavefront-Optimized LASIK: A Randomized Clinical Trial Comparing Contralateral Eyes. J Refract Surg 2011; 27:245-50. [DOI: 10.3928/1081597x-20100812-02] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Accepted: 07/06/2010] [Indexed: 11/20/2022]
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Hashemi H, Nazari R, Amoozadeh J, Beheshtnejad AH, Jabbarvand M, Mohammadpour M, Hashemian H. Comparison of postoperative higher-order aberrations and contrast sensitivity: Tissue-saving versus conventional photorefractive keratectomy for low to moderate myopia. J Cataract Refract Surg 2010; 36:1732-40. [DOI: 10.1016/j.jcrs.2010.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 04/13/2010] [Accepted: 04/27/2010] [Indexed: 11/24/2022]
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Response to: Comparison of higher-order aberration and optical quality after Epi-LASIK and LASIK for myopia. Graefes Arch Clin Exp Ophthalmol 2010; 249:1559-60. [PMID: 20853115 DOI: 10.1007/s00417-010-1515-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 09/01/2010] [Indexed: 10/19/2022] Open
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Hori-Komai Y, Toda I, Yamamoto TT, Tsubota K. Comparison of LASIK with the OPDCAT or OATz algorithm using the NIDEK EC-5000CXII excimer laser. J Refract Surg 2010; 26:411-22. [PMID: 19681511 DOI: 10.3928/1081597x-20090617-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2008] [Accepted: 05/07/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare refractive outcomes, higher order aberrations, visual quality, and patient satisfaction between aspheric and whole-eye wavefront aspheric LASIK algorithms. METHODS Two hundred seventy-four eyes of 152 patients undergoing LASIK for myopia and myopic astigmatism were divided into two groups: eyes that underwent treatment using either the OPD-guided customized aspheric treatment (OPDCAT) or optimized aspheric treatment zone (OATz). Both groups were subdivided into two groups based on preoperative manifest refraction spherical equivalent (MRSE) <or= 6.00 diopters (D) and eyes with MRSE >or = - 6.00 D. Both groups were additionally subdivided into eyes with preoperative ocular higher order aberrations <0.40 microm and eyes with higher order aberrations >or = 0.40 microm. A P value <.05 was considered statistically significant. RESULTS At 3 months postoperatively, 88.3% (242/274) of eyes were available for follow-up. Postoperatively, 91.4% of eyes in the OPDCAT group and 90.6% of eyes in the OATz group were within 0.50 D. No difference in refractive outcomes and patient satisfaction among groups or subgroups was noted (P>.05). A significantly less change in asphericity (less oblate) was noted for the OPDCAT group (0.31 +/- 0.30) compared with the OATz group (0.51 +/- 0.35) (P<.05). A lower induction of aberrations in the OPDCAT group compared with the OATz group was noted ( P<.05). Mesopic contrast sensitivity was significantly higher for the OPDCAT groups and subgroups (P<.05). CONCLUSIONS Refractive outcomes between groups or subgroups were equivalent. A significantly lower induction of higher order aberrations and less change in asphericity in the OPDCAT group was noted. The OPDCAT algorithm was more likely to maintain mesopic contrast sensitivity.
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Affiliation(s)
- Yoshiko Hori-Komai
- Minamiaoyama Eye Clinic, 3-3-11 Kitaaoyama, Minato-ku, Tokyo 107-0061, Japan.
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Barreto J, Barboni MT, Feitosa-Santana C, Sato JR, Bechara SJ, Ventura DF, Alves MR. Intraocular Straylight and Contrast Sensitivity After Contralateral Wavefront-Guided LASIK and Wavefront-Guided PRK for Myopia. J Refract Surg 2010; 26:588-93. [DOI: 10.3928/1081597x-20090930-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 09/03/2009] [Indexed: 11/20/2022]
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Comparison of custom ablation and conventional laser in situ keratomileusis for myopia and myopic astigmatism using the Alcon excimer laser. Cornea 2010; 28:971-5. [PMID: 19724218 DOI: 10.1097/ico.0b013e31819ce213] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the refractive outcomes, higher order aberrations, and contrast sensitivity after laser in situ keratomileusis (LASIK) using wavefront ablation and conventional ablation. SETTING Private practice in Córdoba, Spain and a free-standing outpatient surgery center. METHODS This was a prospective, nonrandomized, observational case series comparing outcomes of 239 eyes that underwent LASIK for myopia and myopic astigmatism with either wavefront or conventional ablation using the LADARVISION excimer laser. Manifest refractive sphere ranged from 0.50 D to -8.00 D with astigmatism up to -4.00 D. Eighty-nine eyes underwent conventional LASIK (conventional group), and 150 eyes underwent custom ablation (custom group). Refractive outcomes, ocular higher order root mean square (HOA-RMS), and contrast sensitivity were tested for statistically significant differences between groups. A P-value less than 0.05 was considered statistically significant. Six month postoperative data are reported here. RESULTS Postoperatively, the mean SE was -0.03 D +/- 0.19 D for the custom group, and -0.14 D +/- 0.35 D for the conventional group (P = 0.003). Ninety-nine percent of the eyes in the custom group, and 92% of the eyes in the conventional group were within 0.50 D of the intended correction (P > 0.05). The HOA-RMS was 0.16 mum lower in the custom group (P < 0.001). Contrast sensitivity was statistically significantly better at 3 cycles per degree (cpd) (P < 0.001) and 6 cpd (P = 0.009) in the custom group. CONCLUSION There was a statistically significant lower induction of HOA-RMS and better predictability and contrast sensitivity in eyes that underwent custom ablation with the LADARVISION excimer laser.
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Hong JT, Lee J, Kim JY, Kim MJ, Tchah H. Clinical Results of Wavefront-guided LASIK. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2010. [DOI: 10.3341/jkos.2010.51.11.1438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jung Taeck Hong
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooeun Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myoung Joon Kim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hungwon Tchah
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Visual performance after implantable collamer lens implantation and wavefront-guided laser in situ keratomileusis for high myopia. Am J Ophthalmol 2009; 148:164-70.e1. [PMID: 19375059 DOI: 10.1016/j.ajo.2009.02.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 01/27/2009] [Accepted: 02/03/2009] [Indexed: 11/24/2022]
Abstract
PURPOSE To compare postoperative visual function after implantable collamer lens (ICL; STAAR Surgical, Nidau, Switzerland) implantation and after wavefront-guided laser in situ keratomileusis (WFG-LASIK) in eyes with high myopia. DESIGN Retrospective, observational case study. METHODS We investigated 46 eyes of 33 patients undergoing ICL implantation and 47 eyes of 29 patients undergoing WFG-LASIK (Technolas217z; Bausch & Lomb, Rochester, New York, USA) for the correction of high myopia (manifest spherical equivalent < or = -6 diopters). Ocular higher-order aberrations (HOA) and contrast sensitivity (CS) function were measured by Hartmann-Shack aberrometry (KR-9000; Topcon, Tokyo, Japan) and a CS unit (VCTS-6500; Vistech Consultants Inc, Dayton, Ohio, USA) before and 3 months after surgery, respectively. From the CS, the area under the log CS function (AULCSF) was calculated. RESULTS For a 4-mm pupil, the changes in ocular coma-like aberrations, spherical-like aberrations, and total HOAs after ICL implantation were significantly less than those after WFG-LASIK (P < .001, Mann-Whitney U test). The postoperative AULCSF was significantly increased after ICL implantation (P < .001), whereas after WFG-LASIK, it was significantly decreased (P < .001). CONCLUSIONS ICL implantation induces significantly fewer ocular HOAs than WFG-LASIK. Moreover, CS was improved significantly after ICL implantation, but deteriorated after WFG-LASIK in eyes with high myopia. Thus, in the correction of high myopia, ICL implantation seems to be superior in visual performance to WFG-LASIK, suggesting that it may be a better surgical option for the treatment of such eyes.
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Schallhorn SC, Tanzer DJ, Kaupp SE, Brown M, Malady SE. Comparison of night driving performance after wavefront-guided and conventional LASIK for moderate myopia. Ophthalmology 2009; 116:702-9. [PMID: 19344822 DOI: 10.1016/j.ophtha.2008.12.038] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 11/19/2008] [Accepted: 12/15/2008] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare preoperative and postoperative changes in simulated night driving performance after wavefront-guided (wLASIK) and conventional LASIK (cLASIK) for the treatment of moderate myopia. DESIGN Retrospective, comparative study. PARTICIPANTS All eyes of subjects with a preoperative manifest spherical equivalent (MSE) between -4.50 and -6.00 who underwent night driving simulator (NDS) testing from 2 clinical trials were entered into the study. This comprised 38 cLASIK patients (62 eyes; mean -5.46 diopters [D] MSE) and 21 wLASIK patients (36 eyes, mean -5.20 D MSE). METHODS Patients' records were reviewed from 2 LASIK clinical trials that had similar enrollment criteria. One trial treated patients with conventional LASIK using a bladed microkeratome (cLASIK) and the other treated with a wavefront-guided profile using a femtosecond laser (wLASIK). In both trials, patients with moderate myopia were asked to participate in NDS testing. MAIN OUTCOME MEASURES The detection and identification distances of road hazards were measured with and without a glare source before and 6 months after LASIK. Each eye was tested independently in best-corrected trial frames by a masked operator. RESULTS In every category, there was a mean reduction in the preoperative to postoperative NDS performance after cLASIK (mean change, -21.3 to -27.9 ft, -6.5 to -8.5 m; 95% confidence interval [CI], -12.0 to -41.3 ft, -3.7 to -12.6 m); there was a corresponding mean improvement after wLASIK (mean change +15.0 to +29.1 ft, +4.6 to +8.9 m; 95% CI, +8.3 to +41.5 ft, +2.5 to +12.6 m). Significant differences between cLASIK and wLASIK NDS performance was observed in every category (P<0.;01, Tukey's honest significant difference for unequal numbers). A clinical relevant loss of NDS performance (>0.5 seconds) was observed in 32% to 38% of cLASIK eyes for all tasks, whereas only 0% to 3% of eyes had this loss after wLASIK. Between 2% and 7% of cLASIK eyes and 11% and 31% of eyes had a significant postoperative improvement in NDS performance in every task. CONCLUSIONS Wavefront-guided LASIK to correct myopia combined with a femtosecond laser flap significantly improved mean night driving visual performance and was significantly better than cLASIK using a mechanical keratome.
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Affiliation(s)
- Steve C Schallhorn
- The Navy Refractive Surgery Center, Naval Medical Center, San Diego, California, USA.
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Yamaguchi T, Negishi K, Kato N, Arai H, Toda I, Tsubota K. Factors affecting contrast sensitivity with the Artisan phakic intraocular lens for high myopia. J Refract Surg 2009; 25:25-32. [PMID: 19244950 DOI: 10.3928/1081597x-20090101-05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the factors affecting postoperative visual function in eyes with Artisan phakic intraocular lenses (PIOLs). METHODS This study examined a retrospective noncomparative case series. Phakic IOLs were implanted in 60 eyes of 36 patients with high myopia. Contrast sensitivity for spatial frequencies of 1.1, 1.7, 2.6, 4.2, 6.6, and 10:4 cycles per degree with and without glare and wavefront aberrations were measured before and 3 months after surgery. The area under the log contrast sensitivity function (AULCSF) was calculated from the contrast sensitivity. Stepwise regression analysis was used to assess the factors that affected the postoperative AULCSF. RESULTS No significant difference was noted between the preoperative AULCSF without glare and the postoperative AULCSF without glare (P=.886). The mean AULCSF with glare improved significantly after surgery (P=.018). The variables affecting the postoperative AULCSF without glare were axial length (partial regression coefficient B=-0.101, P=.0002) and age (B=-0.008, P=.0063). The variables affecting the postoperative AULCSF with glare were axial length (B=-0.127, P<.0001) and age (B=-0.012, P=.0294). The preoperative refraction showed multicollinearity with the axial length, and coma-like aberration and spherical aberration showed multicollinearity with age. CONCLUSIONS Contrast sensitivity without glare was the same before and after surgery and contrast sensitivity with glare improved after surgery. Longer axial length and older age predispose patients to degradation of the postoperative visual function in eyes with Artisan PIOLs.
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Affiliation(s)
- Takefumi Yamaguchi
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Dougherty PJ, Bains HS. A retrospective comparison of LASIK outcomes for myopia and myopic astigmatism with conventional NIDEK versus wavefront-guided VISX and Alcon platforms. J Refract Surg 2009; 24:891-6. [PMID: 19044229 DOI: 10.3928/1081597x-20081101-07] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
UNLABELLED POSE: To compare visual, refractive, and safety outcomes among a non-wavefront scanning-slit laser (NIDEK EC-5000) and wavefront-driven lasers (Alcon CustomCornea and VISX CustomVue). METHODS A retrospective comparison of outcomes for 290 eyes that underwent LASIK for myopia and myopic astigmatism with either a conventional or custom ablation excimer laser system were compared. The preoperative refractive error and age of the patients were matched. Outcomes were tested for statistically significant differences among the conventional laser and each of the custom ablation lasers. A P value <.05 was considered statistically significant. Data with 3-month follow-up are reported. RESULTS Postoperatively, mean manifest refraction spherical equivalent was -0.12+/-0.31 diopters (D) (range: -1.50 to 0.75 D) for the NIDEK group, -0.13+/-0.39 D (range: -1.88 to 0.75 D) for the VISX group, and -0.06+/-0.26 D (range: -0.75 to 0.75 D) for the Alcon group. Eighty-nine percent of eyes in the NIDEK group, 88% of eyes in the VISX group, and 92% of eyes in the Alcon group were within a half-diopter of intended correction. None of the NIDEK and VISX eyes and 3% of Alcon eyes lost 2 or more lines of best spectacle-corrected visual acuity. No statistically significant differences in any of the outcomes studied between conventional and custom ablation treatments were noted (P>.05). CONCLUSIONS No statistically significant differences were observed in safety, efficacy, or predictability of eyes that underwent conventional ablation with the NIDEK EC-5000 scanning slit laser compared to custom ablation with the VISX CustomVue or Alcon CustomCornea laser systems.
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Affiliation(s)
- Paul J Dougherty
- Dougherty Laser Vision Institute, 1821 Daily Dr, Camarillo, CA 93010, USA.
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Arbelaez MC, Vidal C, Jabri BA, Mosquera SA. LASIK for Myopia with Aspheric “Aberration Neutral” Ablations Using the ESIRIS Laser System. J Refract Surg 2009; 25:991-9. [DOI: 10.3928/1081597x-20091016-04] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Accepted: 10/24/2008] [Indexed: 11/20/2022]
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Mimura T, Azar DT. Current Concepts, Classification, and History of Refractive Surgery. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Affiliation(s)
- Naoyuki Maeda
- Department of Ophthalmology, Osaka University Medical School, Osaka, Japan.
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40
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Wavefront-Guided (Customized) Excimer Laser Refractive Surgery. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00021-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Comparison of Collamer toric implantable [corrected] contact lens implantation and wavefront-guided laser in situ keratomileusis for high myopic astigmatism. J Cataract Refract Surg 2008; 34:1687-93. [PMID: 18812119 DOI: 10.1016/j.jcrs.2008.06.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 06/14/2008] [Indexed: 11/22/2022]
Abstract
PURPOSE To compare the postoperative visual outcomes after implantation of a Collamer toric implantable contact lens (ICL) and after wavefront-guided laser in situ keratomileusis in high myopic astigmatism. SETTING Department of Ophthalmology, Kitasato University, Kanagawa, Japan. METHODS This study comprised 30 eyes (18 patients) having toric ICL implantation and 24 eyes (17 patients) having wavefront-guided LASIK (Technolas 217z) to correct high myopic astigmatism (manifest spherical equivalent [SE] <or=-6.0 diopters [D]; manifest refractive cylinder >or=1.0 D). The safety, efficacy, predictability, stability, and adverse events were assessed preoperatively and 1 week and 1, 3, and 6 months postoperatively. RESULTS At 6 months, the mean safety index was 1.28+/-0.25 (SD) in the ICL group and 1.01+/-0.16 in the LASIK group and the mean efficacy index, 0.87+/-0.15 and 0.83+/-0.23, respectively. All eyes in the ICL group and 71% of eyes in the LASIK group were within +/-1.00 D of the targeted SE correction at 6 months. The mean change in manifest refraction from 1 week to 6 months was -0.04+/-0.24 D in the ICL group and -0.60+/-0.49 D in the LASIK group. There were no significant complications in the ICL group; 2 eyes (8.3%) in the LASIK group required enhancement ablations. CONCLUSION Toric ICL implantation was better than wavefront-guided LASIK in eyes with high myopic astigmatism in almost all measures of safety, efficacy, predictability, and stability, suggesting that toric ICL implantation may become a viable surgical option to treat high myopic astigmatism.
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Wavefront-guided laser in situ keratomileusis in the treatment of high myopia by using the CustomVue wavefront platform. Cornea 2008; 27:787-90. [PMID: 18650664 DOI: 10.1097/ico.0b013e31816a3554] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the efficacy, predictability, and safety of wavefront-guided laser in situ keratomileusis (LASIK) in the treatment of high myopia by using the Visx S4 CustomVue wavefront platform. METHODS A retrospective analysis of consecutive cases of eyes with high myopia (manifest refraction spherical equivalent >or= -6.00 D) that underwent non-physician-adjusted wavefront-guided LASIK by using the Visx S4 CustomVue wavefront platform. Forty-three eyes of 29 patients were included. Preoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction, WaveScan refraction, postoperative uncorrected visual acuity (UCVA) and BSCVA, and manifest refraction were determined. The clinical outcomes were evaluated on the basis of standard formats and criteria. Data at 3 months postoperatively are presented. RESULTS Preoperatively, we found mean sphere was -6.89 +/- 1.08 D, mean cylinder was -0.97 +/- 0.75 D, and mean spherical equivalent (SE) was -7.38 +/- 1.20 D. Postoperatively, mean sphere was 0.02 +/- 0.40 D, mean cylinder was -0.40 +/- 0.40 D, and mean SE was -0.18 +/- 0.43 D. UCVA was 20/15 or better in 27.9% and cumulatively 20/20 or better in 58% of eyes. All eyes treated had at least 20/50 UCVA. Efficacy index was 0.94. Eighty-two percent of eyes were within 0.50 D and 97.6% were within 1.00 D of emmetropia at the 3-month follow-up visit. Ninety-one percent of eyes either maintained or gained 1 line of BSCVA. No eye lost >1 line of BSCVA. The safety index was 1.1. CONCLUSIONS The 3-month follow-up results of our study indicate that wavefront-guided LASIK by using the Visx S4 CustomVue wavefront platform is an effective, predictable, and safe treatment of high myopia.
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Bababeygy SR, Zoumalan CI, Chien FY, Manche EE. Wavefront-guided laser in situ keratomileusis retreatment for consecutive hyperopia and compound hyperopic astigmatism. J Cataract Refract Surg 2008; 34:1260-6. [DOI: 10.1016/j.jcrs.2008.04.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Accepted: 03/23/2008] [Indexed: 11/25/2022]
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Schallhorn SC, Farjo AA, Huang D, Boxer Wachler BS, Trattler WB, Tanzer DJ, Majmudar PA, Sugar A. Wavefront-guided LASIK for the correction of primary myopia and astigmatism a report by the American Academy of Ophthalmology. Ophthalmology 2008; 115:1249-61. [PMID: 18598819 DOI: 10.1016/j.ophtha.2008.04.010] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 03/28/2008] [Accepted: 04/08/2008] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe wavefront-guided (WFG) LASIK for the primary treatment of low to moderate levels of myopia and astigmatism and to examine the evidence on the safety and effectiveness of the procedure in comparison with conventional LASIK. METHODS Literature searches conducted in 2004, 2005, 2006, and 2007 retrieved 209 unique references from the PubMed and Cochrane Library databases. The panel selected 65 articles to review, and of these, chose 45 articles that they considered to be of sufficient clinical relevance to submit to the panel methodologist for review. During the review and preparation of this assessment, an additional 2 articles were included. A level I rating was assigned to properly conducted, well-designed, randomized clinical trials; a level II rating was assigned to well-designed cohort and case-controlled studies; and a level III rating was assigned to case series, case reports, and poorly designed prospective and retrospective studies. In addition, studies that were conducted by laser manufacturers before device approval (premarket approval) were reviewed as a separate category of evidence. RESULTS The assessment describes studies reporting results of WFG LASIK clinical trials, comparative trials, or both of WFG and conventional LASIK that were rated level II and level III. There were no studies rated as level I evidence. Four premarket approval studies conducted by 4 laser manufacturers were included in the assessment. The assessment did not compare study results or laser platforms because there were many variables, including the amount of follow-up, the use of different microkeratomes, and the level of preoperative myopia and astigmatism. CONCLUSIONS There is substantial level II and level III evidence that WFG LASIK is safe and effective for the correction of primary myopia or primary myopia and astigmatism and that there is a high level of patient satisfaction. Microkeratome and flap-related complications are not common but can occur with WFG LASIK, just as with conventional LASIK. The WFG procedure seems to have similar or better refractive accuracy and uncorrected visual acuity outcomes compared with conventional LASIK. Likewise, there is evidence of improved contrast sensitivity and fewer visual symptoms, such as glare and halos at night, compared with conventional LASIK. Even though the procedure is designed to measure and treat both lower- and higher-order aberrations (HOAs), the latter are generally increased after WFG LASIK. The reasons for the increase in HOA are likely multifactorial, but the increase typically is less than that induced by conventional LASIK. No long-term assessment of WFG LASIK was possible because of the relatively short follow-up (12 months or fewer) of most of the studies reviewed.
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Affiliation(s)
- Steven C Schallhorn
- American Academy of Ophthalmology, Quality Care and Knowledge Base Development, P.O. Box 7424, San Francisco, CA 94120-7424, USA
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Padmanabhan P, Mrochen M, Basuthkar S, Viswanathan D, Joseph R. Wavefront-guided versus wavefront-optimized laser in situ keratomileusis: contralateral comparative study. J Cataract Refract Surg 2008; 34:389-97. [PMID: 18299062 DOI: 10.1016/j.jcrs.2007.10.028] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 10/22/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the outcomes of wavefront-guided and wavefront-optimized treatment in fellow eyes of patients having laser in situ keratomileusis (LASIK) for myopia. SETTING Medical and Vision Research Foundation, Tamil Nadu, India. METHODS This prospective comparative study comprised 27 patients who had wavefront-guided LASIK in 1 eye and wavefront-optimized LASIK in the fellow eye. The Hansatome (Bausch & Lomb) was used to create a superior-hinged flap and the Allegretto laser (WaveLight Laser Technologie AG), for photoablation. The Allegretto wave analyzer was used to measure ocular wavefront aberrations and the Functional Acuity Contrast Test chart, to measure contrast sensitivity before and 1 month after LASIK. The refractive and visual outcomes and the changes in aberrations and contrast sensitivity were compared between the 2 treatment modalities. RESULTS One month postoperatively, 92% of eyes in the wavefront-guided group and 85% in the wavefront-optimized group had uncorrected visual acuity of 20/20 or better; 93% and 89%, respectively, had a postoperative spherical equivalent refraction of +/-0.50 diopter. The differences between groups were not statistically significant. Wavefront-guided LASIK induced less change in 18 of 22 higher-order Zernike terms than wavefront-optimized LASIK, with the change in positive spherical aberration the only statistically significant one (P= .01). Contrast sensitivity improved at the low and middle spatial frequencies (not statistically significant) and worsened significantly at high spatial frequencies after wavefront-guided LASIK; there was a statistically significant worsening at all spatial frequencies after wavefront-optimized LASIK. CONCLUSION Although both wavefront-guided and wavefront-optimized LASIK gave excellent refractive correction results, the former induced less higher-order aberrations and was associated with better contrast sensitivity.
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Neuhann T, Neuhann IM, Hassel JM. [Aspheric profiles for refractive laser ablation of the cornea]. Ophthalmologe 2008; 105:241-7. [PMID: 18311567 DOI: 10.1007/s00347-008-1723-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Conventional ablation profiles for excimer lasers for myopic refractive correction of the cornea are of spheric geometry. Therefore, they induce additional imaging aberrations into the optical system of the eye, most notably spherical aberration. This is a major cause of the observed deterioration of visual quality after such corrections, especially under low illumination and ensuing larger pupil diameter. Therefore, aspheric ablation profiles compromizing the preexisting imaging/visual quality of the eye as little as possible are currently being developed and optimized for all laser platforms. Employed methods include customized correction profiles on the basis of individual wavefront data of the anterior corneal topography on the one hand, and correction profiles that minimize the induced spherical aberration in a "standardized" way on the other hand. We demonstrate for a particular laser platform how such profiles must be developed and optimized. Mathematical theoretical calculations appear to be an indispensable but insufficient prerequisite. The biological reaction of the corneal stroma and epithelium ("biodynamic response") can only be determined experimentally and must lead to adjustment of the calculated ablation algorithm. The results show that aspheric profiles developed on this basis can lead to significant reduction of induced spherical aberration. The obtainable effect is, however, limited by the biological response and the ensuing peripheral ablation depth and volume.
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Affiliation(s)
- Th Neuhann
- alz augenklinik münchen, Bayerstrasse 3, 80335, München, Deutschland.
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Ghosh S, Couper TA, Lamoureux E, Jhanji V, Taylor HR, Vajpayee RB. Evaluation of iris recognition system for wavefront-guided laser in situ keratomileusis for myopic astigmatism. J Cataract Refract Surg 2008; 34:215-21. [DOI: 10.1016/j.jcrs.2007.09.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 09/02/2007] [Indexed: 10/22/2022]
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Corneal wavefront–guided enhancement for high levels of corneal coma aberration after laser in situ keratomileusis. J Cataract Refract Surg 2008; 34:222-31. [DOI: 10.1016/j.jcrs.2007.09.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Accepted: 09/24/2007] [Indexed: 11/22/2022]
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Bühren J, Kohnen T. [Application of wavefront analysis in clinical and scientific settings. From irregular astigmatism to aberrations of a higher order--Part II: examples]. Ophthalmologe 2008; 104:991-1006; quiz 1007-8. [PMID: 18030477 DOI: 10.1007/s00347-007-1648-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In recent years, wavefront analysis has ceased to be purely a laboratory application and emerged as a method used in ophthalmological diagnosis. This development has been promoted mainly by the widespread use of wavefront-guided LASIK (laser in situ keratomileusis). However, aberrometry is still not a common diagnostic technique, and for many ophthalmologists interpretation of the results is difficult. The second part of this serial paper reviews findings that are relevant for the ophthalmological community and highlights current scientific applications in this area.
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Affiliation(s)
- J Bühren
- Advanced Physiological Optics Lab, Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
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Alió JL, Piñero D, Muftuoglu O. Corneal wavefront-guided retreatments for significant night vision symptoms after myopic laser refractive surgery. Am J Ophthalmol 2008; 145:65-74. [PMID: 17981258 DOI: 10.1016/j.ajo.2007.08.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2007] [Revised: 08/14/2007] [Accepted: 08/20/2007] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the results of corneal wavefront (WF)-guided enhancements in patients with night vision symptoms and significantly high positive spherical aberration (SA) after myopic laser refractive surgery. DESIGN Noncomparative, interventional case series. METHODS Twenty-eight eyes of 20 patients with significant night vision symptoms and positive corneal SA (Z(4)(0)) higher than 0.5 microm after myopic laser refractive surgery were included in the study at Vissum-Instituto Oftalmologico de Alicante, Spain. Enhancement surgery was planned to remove residual refractive error and corneal SA (Z(4)(0)) in all cases. All patients underwent corneal WF-guided excimer laser retreatments using the ESIRIS/SCHWIND excimer laser system (Schwind Eye Tech Solutions, Kleinostham, Germany). The main outcome measures were visual symptoms, change in corneal SA (Z(4)(0)), and corneal asphericity (Q-value). RESULTS Subjective reports of night vision symptoms were improved in all patients. Mean corneal SA (Z(4)(0)) decreased from 0.75 +/- 0.19 microm before surgery to 0.43 +/- 0.42 microm after surgery (P < .001). Mean asphericity in the 4.5-mm zone significantly decreased from 1.02 +/- 1.07 before surgery to 0.52 +/- 0.88 after surgery (P = .008), and the mean asphericity in 8 mm did not change significantly (P = .362). The mean spherical equivalent significantly shifted to hyperopia from -0.22 +/- 1.14 diopters (D) before surgery to 0.33 +/- 0.54 D after surgery (P = .025). CONCLUSIONS Cornea wavefront-guided retreatment was effective in improving subjective night vision symptoms, reducing corneal SA, and decreasing asphericity in eyes that underwent myopic laser refractive surgery.
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Affiliation(s)
- Jorge L Alió
- Department of Refractive Surgery and Division of Ophthalmology, Instituto Oftalmológico de Alicante, Miguel Hernandez University, Alicante, Spain.
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