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Ahluwalia A, Ma KK, Manche EE. Patient-Reported Outcomes and Higher Order Aberrations Following Topography-Guided Femtosecond Laser-Assisted In Situ Keratomileusis. Cornea 2024:00003226-990000000-00570. [PMID: 38830188 DOI: 10.1097/ico.0000000000003581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/21/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE To examine patient-reported outcomes and higher order aberrations following topography-guided laser-assisted in situ keratomileusis (LASIK). METHODS This was a prospective, nonrandomized observational study at a single academic center. Sixty eyes from 30 patients underwent bilateral topography-guided femtosecond LASIK for correction of myopia using the VisuMax 500 femtosecond laser (Zeiss; Oberkochen, Germany) and Allegretto Wave Eye-Q 400 Hz Excimer Laser (Alcon/Wavelight; Erlangen, Germany) with the Contoura topography system (Alcon; Geneva, Switzerland) for topography-modified refraction. The main outcomes of this study were higher order aberrations (HOAs) and results from the Patient-Reported Outcomes with LASIK questionnaire. RESULTS There was a small, significant increase in HOA root mean square, spherical aberration, and coma at 1, 3, 6, and 12 months following topography-guided LASIK (all P < 0.05), but no change in trefoil. In addition, self-reported worry related to vision (P < 0.001) and ability to perform activities (P < 0.001) significantly improved after surgery. The prevalence of double images, glare, halos, or starbursts decreased from 73% preoperatively to 56%, and no participants reported "very" or "extremely" bothersome visual symptoms after 12 months. Dry eye symptoms per Ocular Surface Disease Index score decreased significantly at 6 (P = 0.01) and 12 (P = 0.002) months after surgery. There was a 100% satisfaction rate with visual outcomes and duration of time to improvement in vision following the procedure. CONCLUSIONS Although there was an increase in HOAs following topography-guided LASIK, there were significant improvements in the presence of double images, glare, halos, and starbursts and vision-related quality-of-life metrics. Overall satisfaction rates in this study were high.
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Affiliation(s)
- Aneesha Ahluwalia
- Department of Ophthalmology, Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA
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İpek ŞC, Utine CA. Topography-guided excimer laser ablation in refractive surgery. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1367258. [PMID: 38984110 PMCID: PMC11182089 DOI: 10.3389/fopht.2024.1367258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/22/2024] [Indexed: 07/11/2024]
Affiliation(s)
| | - Canan Asli Utine
- Department of Opthalmology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
- İzmir Biomedicine and Genome Center, İzmir, Türkiye
- Department of Ophthalmology, University of Naples Federico II, Napoli, Italy
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Onishi AC, Lee-Choi C, Marvasti AH. Topography-guided excimer laser ablation. Curr Opin Ophthalmol 2023; 34:296-302. [PMID: 37014746 DOI: 10.1097/icu.0000000000000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
PURPOSE OF REVIEW Currently, the most commonly performed corneal refractive surgery is laser-assisted in-situ keratomileusis (LASIK). Customized forms of LASIK have been developed, which have allowed for improved outcomes and the enhanced correction of higher order aberrations (HOAs). This review discusses one form of custom LASIK, topography-guided LASIK, including factors involved in preoperative planning, and advantages and disadvantages compared with other forms of keratorefractive surgery. RECENT FINDINGS Various treatment-planning approaches addressing discrepancies between the refractive and topographic astigmatic magnitude and axis have been used successfully, although there is debate regarding a superior method in the literature. SUMMARY There are many forms of custom LASIK, which provide excellent outcomes. Topography-guided LASIK may be of particular use in highly aberrated corneas and may also provide outstanding outcomes in healthy eyes given its emphasis on treating the primary refractive surface of the eye.
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Affiliation(s)
- Alex C Onishi
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at the University of California, Los Angeles
| | | | - Amir H Marvasti
- Department of Ophthalmology, Stein Eye Institute, David Geffen School of Medicine at the University of California, Los Angeles
- Coastal Vision Medical Group, Orange, California, USA
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Sachdev GS, Ramamurthy S, Soundarya B, Dandapani R. Comparative analysis of outcomes following topography-guided laser in situ keratomileusis using manifest refraction versus a new topographic analysis algorithm. Indian J Ophthalmol 2023; 71:2430-2435. [PMID: 37322655 PMCID: PMC10418009 DOI: 10.4103/ijo.ijo_226_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To compare the visual outcomes following topography-guided laser in situ keratomileusis (LASIK) treatment using manifest refraction versus a new topography analysis software. Methods A prospective, randomized, observer-masked contralateral study was conducted in the refractive services of a tertiary eye care hospital in South India. Analysis of visual outcomes, corneal higher-order aberrations, and contrast sensitivity were performed at 3 months postoperative visit following uneventful topography-guided LASIK using the Wavelight EX500. One eye was treated with the Contoura platform using manifest refraction (Contoura), while the contralateral eye was treated using an ablation profile planned by the Phorcides Analytic Engine (Phorcides). Results Sixty eyes of 30 patients were included in the study. At 3 months postoperative visit, the uncorrected distance visual acuity (UDVA) in the Contoura and Phorcides groups was logarithm of the minimal angle of resolution (logMAR) 0.04 ± 0.07 and logMAR 0.06 ± 0.1, respectively (P = 0.483). Postoperative manifest refractive spherical error (MRSE) was 0.12 ± 0.22 and - 0.06 ± 0.20 D in the Contoura and Phorcides groups, respectively (P = 0.338). Although higher number of eyes demonstrated a gain in one or more lines of corrected distance visual acuity (CDVA) in the Contoura group (16.6% vs. 6.6%), the difference was not statistically significant (P = 0.361). Vector analysis (Alpins criteria) for postoperative cylinder, contrast sensitivity measurement, and corneal higher-order aberration profile showed no significant difference between the two groups at 3 months postoperative visit (P = 0.213, 0.514, and 0.332, respectively). Conclusion Quantitative and qualitative visual outcomes with the Phorcides Analytic Software were similar to the Contoura treatment using manifest refraction.
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Affiliation(s)
- Gitansha S Sachdev
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Shreyas Ramamurthy
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - B Soundarya
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Ramamurthy Dandapani
- Cornea and Refractive Services, The Eye Foundation, Coimbatore, Tamil Nadu, India
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Higher-Order Aberrations of Topography-Guided LASIK and Wavefront-Optimized LASIK in High- and Low-Myopic Eyes: A Non-Randomized Controlled Trial. J Pers Med 2023; 13:jpm13030399. [PMID: 36983581 PMCID: PMC10055775 DOI: 10.3390/jpm13030399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
We aimed to investigate high-order aberration (HOA) change between topography-guided (TG) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) in patients with different degrees of myopia. A non-randomized clinical trial was conducted, in which 40 eyes of 20 patients aged 20–50 years old were included. Participants received TG-LASIK in one eye and WFO-LASIK on the alternate eye. Corneal topography and HOAs including coma, trefoil, spherical aberration (SA), and contrast sensitivity (CS) were collected. Moreover, a quality of vision (QoV) questionnaire was completed by each participant. Non-parametric tests were used to infer the difference in HOAs and CS between the TG-LASIK and WFO-LASIK groups, and subgroup analyses stratified by myopia degree were performed. The high-myopia patients with TG-LASIK showed more coma and SA compared to low-myopia individuals (all 95% CI lower limits > 0), and subjects who received WFO-LASIK exhibited more SA in high-myopia status (both 95% CI lower limits > 0). The TG-LASIK group showed lower postoperative trefoil compared to the WFO-LASIK group in the high-myopia population (mean difference: −0.1267, 95% CI: −0.24 to −0.01). The TG-LASIK group yielded less surgically induced haze, better clarity at night, and better total quality scores (all p < 0.05). In conclusion, TG-LASIK might yield less postoperative trefoil in high-myopia patients and higher QoV in the general population compared to the WFO-LASIK procedure.
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Brunson P, Mann PM, Mann PM, Potvin R. Comparison of refractive and visual acuity results after Contoura® Vision topography-guided LASIK planned with the Phorcides Analytic Engine to results after wavefront-optimized LASIK in eyes with oblique astigmatism. PLoS One 2022; 17:e0279357. [PMID: 36534673 PMCID: PMC9762561 DOI: 10.1371/journal.pone.0279357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To compare visual acuity and refractive results between topography-guided laser in situ keratomileusis (LASIK) planned with the Phorcides Analytic Engine (PAE) to results after wavefront-optimized (WFO) LASIK in subjects with preoperative oblique astigmatism in their manifest refraction. METHODS This was a retrospective chart review of clinical results from eyes treated with topography-guided LASIK planned with PAE compared to eyes treated with WFO LASIK using the same Wavelight® excimer laser system. All included subjects had preoperative oblique astigmatism. Residual refractive error and visual acuity (uncorrected and corrected) were the measures of interest, at the visit closest to 90 days postoperative. RESULTS A matched data set from 100 WFO and 97 PAE eyes was extracted from clinical records. At the postoperative visit the PAE group showed lower residual refractive cylinder (p = 0.04), uncorrected distance visual acuity (UDVA) (-0.06 PAE vs. -0.02 WFO, p < 0.01) and distance corrected visual acuity (CDVA) (p < 0.01). The percentage of eyes with a mean refraction spherical equivalent (MRSE) magnitude within 0.25 D and 0.50 D of plano was statistically significantly higher in the PAE group (p = 0.04 and 0.01, respectively). A statistically significantly higher percentage of eyes in the PAE group had UDVA better than or equal to -0.10 logMAR (20/16 Snellen, 36% vs 22%, p = 0.04). More eyes gained CDVA after surgery in the PAE group (53% vs 32%, p < 0.01). There were five enhancements in the WFO group versus none in the PAE group, a statistically significant difference (p = 0.03). CONCLUSIONS Visual acuity and refractive outcomes after LASIK using PAE in eyes with oblique astigmatism in their preoperative refraction were statistically significantly better than those obtained when WFO treatment was used. The number of refractive outliers and the number of retreatments were also significantly lower with PAE treatment.
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Affiliation(s)
- Phillip Brunson
- Mann Eye Institute and Laser Centers, Houston, TX, United States of America
- * E-mail:
| | - Paul M. Mann
- Mann Eye Institute and Laser Centers, Houston, TX, United States of America
| | - Paul Michael Mann
- Mann Eye Institute and Laser Centers, Houston, TX, United States of America
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González-Cruces T, Villarrubia A, Sánchez Ventosa Á, Palacín Miranda E, Castillo Eslava R, Gomera Martinez A, García Párrizas JA, Torres Huelva P, Sánchez-González JM, Cano-Ortiz A. Comparison Between the Wavefront-Optimized and Custom-Q Aspheric Ablation Profiles in Myopic Eyes With Two Different Q-targets: A Contralateral Eye Study. J Refract Surg 2022; 38:698-707. [DOI: 10.3928/1081597x-20221005-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alves EM, Lyra AF, Tenório M, Mesquita N, Bacelar C, Montenegro A, Alves L, Alves M. Femtosecond laser-assisted in situ keratomileusis with topography-guided or asphericity-adjusted derived data: a comparative contralateral eye study. BMC Ophthalmol 2022; 22:189. [PMID: 35468752 PMCID: PMC9040263 DOI: 10.1186/s12886-022-02407-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 04/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Wavefront-optimized laser-assisted in situ keratomileusis (LASIK) ablation is the most commonly performed procedure in refractive surgery, but new technologies have become available. Our goal was to compare topography-guided (Contoura) and asphericity-guided (Custom-Q) customized ablation treatments for the correction of myopia with or without astigmatism. Methods This prospective, randomized, double-blind, contralateral eye study included 60 eyes of 30 patients with myopia or myopic astigmatism requiring femtosecond LASIK (FemtoLASIK) treatment. For each patient, one eye was randomized to undergo Contoura treatment, and the other underwent Custom-Q abaltion. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refractive spherical equivalent (MRSE), sphere (SPH), cylinder (CYL), 6.0-mm total corneal aberration root mean square (RMS), coma (COMA), trefoil (TREF), and spherical aberration (SA) were measured and analysed after a 1-year follow-up. Results The UDVA was − 0.08 ± 0.06 logMAR in Contoura eyes and − 0.08 ± 0.05 logMAR in Custom-Q eyes (p = 0.309) after 12 months. Twenty-five eyes (83%) in the Contoura group and twenty-six eyes (87%) in the Custom-Q group had a UDVA of 20/16 at the end of 12 months, and 100% of eyes in both groups reached a UDVA of 20/25 or better. Ninety and 100% of eyes in the Contoura and Custom-Q groups, respectively, achieved a residual CYL ≤0.50 D (p = 0.237). No statistically significant difference was observed between the surgical techniques in the preoperative to 1-year postoperative changes for any of the parameters evaluated (MRSE, CYL, RMS, DEF, COMA, TREF, and SA). Conclusions The Contoura and Custom-Q techniques yielded excellent visual and refractive results, but the evidence did not reveal any clear differences between these two methods after 1 year of follow-up. Trial registration ReBEC - Registro Brasileiro de Ensaios Clínicos [Internet]: Rio de Janeiro (RJ): Instituto de Informação Científica e Tecnológica em Saúde (Brazil); 2010 -. Identifier RBR-8rs5kt Myopia and Astigmatism Topography-guided Refractive Surgery by Contoura Method Versus Customized by Asphericity in Contralateral Eyes: A prospective Double blind Randomized Study. Available from https://ensaiosclinicos.gov.br/rg/RBR-8rs5kt Date of registration: 02/03/2020 (dd/mm/yyyy). CAAE:96778718.9.0000.5192. Issuing authority: Plataforma Brasil. CEP:2.979.279. Issuing authority: HUOC.
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Affiliation(s)
- Ermano M Alves
- Oftalmax, Rua Benfica, 411, Madalena, Recife, PE, 50720-001, Brazil.
| | - Adriana F Lyra
- Hospital Santa Luzia, Estrada do Encanamento, 909, Casa Forte, Recife, PE, Brazil
| | - Manuela Tenório
- Oftalmax, Rua Benfica, 411, Madalena, Recife, PE, 50720-001, Brazil
| | - Natália Mesquita
- Oftalmax, Rua Benfica, 411, Madalena, Recife, PE, 50720-001, Brazil
| | - Carolina Bacelar
- Hospital Santa Luzia, Estrada do Encanamento, 909, Casa Forte, Recife, PE, Brazil
| | - Afra Montenegro
- Oftalmax, Rua Benfica, 411, Madalena, Recife, PE, 50720-001, Brazil
| | | | - Márcio Alves
- FPS-IMIP, Av Mal. Mascarenhas de Morais, Recife, PE, 4861, Brazil
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Alpins N, Ong JKY, Stamatelatos G. Hemidivisional vector planning to reduce and regularize irregular astigmatism by laser treatment. Graefes Arch Clin Exp Ophthalmol 2022; 260:3095-3106. [PMID: 35262765 PMCID: PMC9418348 DOI: 10.1007/s00417-022-05604-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/03/2022] [Accepted: 02/21/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To demonstrate how hemidivisional vector planning of refractive laser treatments of astigmatism can be used to directly address idiopathic corneal irregular astigmatism that has an asymmetrical, non-orthogonal bow tie topography appearance. DESIGN Case study. METHODS The cornea is conceptually divided into two hemidivisions along the flat meridian of the corneal topographic astigmatism (CorT), which means that each hemidivision will approximately correspond to one lobe of the asymmetric, non-orthogonal topographic bow tie. An astigmatism reduction treatment can then be planned separately for each hemidivision using the vector planning technique, based on both its two hemidivisional CorT measures and common manifest refractive cylinder. The remaining irregularity is then regularized, and the junctional zone smoothed across the flat meridian. The final intended treatment thus combines hemidivisional astigmatism reduction and regularization of the corneal astigmatism and spherical refractive error in one treatment application. This could be applied to LASIK, PRK, SMILE, and Transepithelial PRK procedures using Designer Cornea® software. RESULTS A theoretical treatment profile is derived from an actual example of a cornea with idiopathic asymmetric non-orthogonal astigmatism. The three steps of the derivation are as follows: (i) astigmatism reduction through the use of the vector planning technique; (ii) regularization, and (iii) smoothing across the hemidivisional midline. CONCLUSIONS Hemidivisional vector planning treatments could potentially both reduce and regularize asymmetric non-orthogonal astigmatism. These treatments can be systematically customized to account for qualitative and quantitative differences between the two corneal hemidivisions at the same time as correction of coexistent myopia or hyperopia.
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Affiliation(s)
- Noel Alpins
- Department of Ophthalmology, Centre of Eye Research (CERA), The University of Melbourne, 160 Victoria Parade, East Melbourne, VIC, 3002, Australia. .,NewVision Clinics, Melbourne, Australia.
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Gui X, Zhang R, Li S, Zhao N, Zhang HR, Zhou YK, Huan CY, Zhao CY, Wang HY, Song HY, Shen W, Zhang JH. Comparative analysis of the clinical outcomes between wavefront-guided and conventional femtosecond LASIK in myopia and myopia astigmatism. Int J Ophthalmol 2021; 14:1581-1588. [PMID: 34667736 DOI: 10.18240/ijo.2021.10.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/20/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the clinical outcomes of wavefront guided femtosecond LASIK (WFG LASIK) and conventional femtosecond LASIK (NWFG LASIK) in eyes with myopia and myopia astigmatism. METHODS This was a retrospective, nonrandomized, comparative investigation enrolling 236 eyes of 122 patients (18-50y) with low & moderate and high myopia. The WFG group including 97 eyes (50 patients) undergone WFG LASIK and the NWFG group including 139 eyes (72 patients) undergone conventional LASIK. Mean efficacy index, high order aberrations (HOAs), pupil size and the quality of visual questionnaire were evaluated 6mo postoperatively. RESULTS There is no difference between WFG group (-0.054±0.049 in logMAR) and NWFG group (-0.040±0.056) in uncorrected distance visual acuity (UDVA) postoperatively. The myopia astigmatism is higher in WFG group than that in NWFG group (P<0.05). However, the mean efficacy index (MEI) in the WFG group (1.09±0.106) is better than that in the NWFG group (1.036±0.124; P<0.001). Increased HOAs were observed in NWFG group (0.30±0.196) than that in WFG group (0.146±0.188; P<0.001). The pupil size is larger in WFG group (5.15±0.76 mm) than that in NWFG group (4.32±0.52 mm). The patients are satisfied with the clinical surgery, yet WFG group showed better visual quality using the questionnaire survey. Meanwhile, high myopia would result in worse MEI, HOAs and visual quality than low & moderate myopia. CONCLUSION WFG and NWFG FS-LASIK are both effective and safe procedures to correct low & moderate and high myopia, but WFG FS-LASIK gives a better postoperative MEI, aberrometric control and predictable outcome. Meanwhile, WFG FS-LASIK is better than NWFG FS-LASIK in correction of myopia astigmatism. Low & moderate myopia allow better clinical outcomes than high myopia using any surgical method.
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Affiliation(s)
- Xiao Gui
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Rui Zhang
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Sha Li
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Na Zhao
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Hao-Rui Zhang
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Yu-Kun Zhou
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Chen-Yang Huan
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Chun-Yan Zhao
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Hong-Ying Wang
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Hong-Yuan Song
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Wei Shen
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
| | - Jian-Hua Zhang
- Department of Ophthalmology, the First Affiliated Hospital of Naval Medical University, Shanghai 200433, China
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Cheng SM, Tu RX, Li X, Zhang JS, Tian Z, Zha ZW, Ruan KW, Yu AY. Topography-Guided Versus Wavefront-Optimized LASIK for Myopia With and Without Astigmatism: A Meta-analysis. J Refract Surg 2021; 37:707-714. [PMID: 34661478 DOI: 10.3928/1081597x-20210709-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the differences in efficacy, predictability, safety, and visual quality between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) for the treatment of myopia with and without astigmatism. METHODS A comprehensive literature search of PubMed, Embase, the Cochrane library, Web of Science, and ClinicalTrials was used to identify randomized controlled trials (RCTs) comparing TCAT-LASIK with WFO-LASIK for myopia with and without astigmatism up to September 2020. The references of all searched literature were checked as supplements. Literature was screened according to the inclusion and exclusion criteria and relative data were extracted. RevMan software version 5.3.0 (Cochrane Collaboration) was used for meta-analysis. RESULTS A total of seven RCTs (1,168 eyes) were included. There were no statistically significant differences in the ratio of uncorrected distance visual acuity of 20/20 or better (relative risk [RR] = 1.01, 95% CI [0.97 to 1.06], P = .64) and 20/16 or better (RR = 0.96, 95% CI [0.80 to 1.16], P = .69). Compared with WFO-LASIK, TCAT-LASIK achieved a higher proportion of postoperative manifest refractive spherical equivalent within ±0.50 diopters of the target (RR = 1.06, 95% CI [1.02 to 1.11], P = .003) and less surgically induced higher order aberrations (weighted mean difference [WMD] = -0.11, 95% CI [-0.15 to -0.0], P < .00001), spherical aberrations (WMD = -0.04, 95% CI [-0.05 to -0.03], P < .00001), and coma (WMD = -0.15, 95% CI [-0.28 to -0.01], P = .03). No patient lost two or more lines of distance-corrected visual acuity postoperatively in the two groups. CONCLUSIONS This meta-analysis suggests that both TCATLASIK and WFO-LASIK show excellent efficacy, predictability, and safety for myopia. TCAT-LASIK exhibited more accurate postoperative refraction predictability and less surgically induced higher order aberrations, spherical aberrations, and coma. More randomized, prospective, and large sample-sized studies are needed to confirm these conclusions in the long term. [J Refract Surg. 2021;37(10):707-714.].
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Wallerstein A, Gauvin M, Ruyu Qi S, Cohen M. Large Axis Difference Between Topographic Anterior Corneal Astigmatism and Manifest Refractive Astigmatism: Can Topography-Guided LASIK Target the Manifest Axis? J Refract Surg 2021; 37:662-673. [PMID: 34661476 DOI: 10.3928/1081597x-20210712-05] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate whether the degree of astigmatism axis discrepancy between preoperative manifest refractive astigmatism and anterior corneal astigmatism impacts refractive and visual outcomes of primary topography-guided laser in situ keratomileusis (LASIK) targeting the refractive astigmatism, and to provide guidance on treating eyes with very large axis discrepancy. METHODS Comparative retrospective analysis of 25,396 consecutive eyes treated with topography-guided LASIK on the manifest refractive astigmatism. Standard outcomes of the 14,534 eyes with small axis discrepancy (SAD) (Δ in axis ⩽ 10°) were compared to the 2,222 eyes with very large axis discrepancy (VLAD) (Δ in axis ⩾ 45°). Pearson correlation coefficient was used to assess relationships between selected variables. RESULTS The mean axis discrepancy was 4.47 ± 2.92° in SAD eyes, and 65.0 ± 13.4° in VLAD eyes. An equivalent number of eyes achieved a cumulative postoperative unilateral uncorrected distance visual acuity of 20/20 in both the SAD and VLAD groups (93.02% vs 93.42%; P = .4892). The efficacy index (0.98 ± 0.13 vs 0.98 ± 0.07; P = .3931) and the safety index (1.00 ± 0.11 vs 1.00 ± 0.03; P = .4757) were identical between groups. There was no clinically meaningful correlation between the preoperative axis discrepancy and preoperative total root mean square anterior corneal coma, postoperative refractive astigmatism, defocus equivalent, spherical equivalent, and angle of error, all with weak correlation coefficients (R = -0.02, -0.03, -0.02, 0.01, and 0.05). CONCLUSIONS Large preoperative axis discrepancy (45° to 90°) between refractive astigmatism and topography-measured anterior corneal astigmatism does not negatively impact topography-guided LASIK, having identical refractive and visual outcomes compared to eyes with small (0° to 10°) discrepancy. There is no basis to exclude eyes with large axis discrepancy from topography-guided LASIK, and these eyes should be treated on the manifest refractive astigmatism. [J Refract Surg. 2021;37(10):662-673.].
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Hu PC, Li L, Wu XH, Li YQ, Li KW. Visual differences in topography-guided versus wavefront-optimized LASIK in the treatment of myopia: a Meta-analysis. Int J Ophthalmol 2021; 14:1602-1609. [PMID: 34667739 PMCID: PMC8482009 DOI: 10.18240/ijo.2021.10.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the potential differences between topography-guided (TG) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) for the treatment of myopia. METHODS A systematic literature search was performed to determine relevant trials comparing LASIK with TG and WFO from the time of library construction to August 2020, and The PubMed, Cochrane, Web of Science, EMBASE and Chinese databases (i.e. CNKI, CBM, WAN FANG and VIP) were accessed. The data on visual acuity, refractive status and wavefront aberration were retrieved and evaluated from three to six months after surgery. STATA (version 14.0) software was used for statistical analysis. A cumulative Meta-analysis was simultaneously performed. RESULTS Eleven studies with a total of 1425 eyes were incorporated. No statistically significant differences were evident between TG and WFO ablation in the proportion of eyes achieving an uncorrected distance visual acuity (UCVA) of 20/20 or better (P=0.377), gaining one line or more (P=0.05), postoperative cylinder (P=0.40), vertical coma (P=0.593) and horizontal coma (P=0.957). After TG ablation, the proportion of the patients' eyes of which postoperative refraction is within ±0.5 diopter of the target refraction was significantly higher than that undergoes WFO (P=0.003). As opposed to the WFO group, manifest refraction spherical equivalent (MRSE; P=0.000) was lower, and UCVA (P=0.005) was better in the TG group. The higher-order aberrations (HOAs; P=0.000), spherical aberration (P=0.000) and coma (P=0.000) were significantly lower in TG group. The cumulative Meta-analysis illustrated that the proportion of eyes achieving UCVA of 20/20 or better, postoperative refraction within ±0.5 diopter, and MRSE has steady between the two groups. CONCLUSION Both TG-LASIK and WFO-LASIK are safe, effective, and predictable for correcting myopia. TG-LASIK may produce fewer aberration and is more precise than WFO-LASIK.
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Affiliation(s)
- Peng-Cheng Hu
- Department of Ophthalmology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400010, China
| | - Li Li
- Department of Ophthalmology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400010, China
| | - Xian-Hui Wu
- Department of Ophthalmology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400010, China
| | - Yan-Qing Li
- Department of Ophthalmology, the Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400010, China
| | - Ke-Wei Li
- Department of Ophthalmology, the First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing 400016, China
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Clinical outcomes after topography-guided LASIK: comparing results based on a new topography analysis algorithm with those based on manifest refraction. J Cataract Refract Surg 2021; 46:814-819. [PMID: 32176160 DOI: 10.1097/j.jcrs.0000000000000176] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare short-term refractive and visual acuity outcomes after topography-guided laser in situ keratomileusis (LASIK) planned with a new topography analysis system to those based on the manifest refraction. SETTING Four clinical sites in the United States. DESIGN Double-arm, nonmasked, nonrandomized retrospective chart review. METHODS This was a retrospective study of postoperative refraction and visual acuity at least 2 months after uneventful LASIK using the Contoura Vision algorithm on the WaveLight Topolyzer VARIO laser. One arm comprised eyes treated using the manifest refraction (manifest), while the other included eyes treated with an ablation profile determined by the Phorcides Analytic Engine (analytic). RESULTS Clinical results from a matched group of 317 manifest eyes and 323 analytic eyes were available for analysis. Residual refractive results, both sphere and cylinder, were similar between groups. However, significantly more eyes had 20/16 or better (-0.1 logarithm of the minimum angle of resolution) uncorrected distance visual acuity (UDVA) (62.5% analytic, 41.3% manifest) and corrected distance visual acuity (CDVA) (77.1% analytic, 51.4% manifest) in the analytic group. All eyes but 1 had a CDVA of 20/20 or better postoperatively. The number of patients with a UDVA better than their preoperative CDVA was significantly higher in the analytic group (36.5%) relative to the manifest group (23.0%). No eye in either group lost more than 1 line of CDVA; significantly more eyes in the analytic group (42.7%) gained 1 or more lines of CDVA relative to the manifest group (30.3%). CONCLUSIONS Using the Phorcides Analytic Engine for topography-guided surgery planning increased the likelihood of 20/16 UDVA and CDVA relative to using the manifest refraction.
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[Excimer laser in keratoconus management]. J Fr Ophtalmol 2021; 44:564-581. [PMID: 33573798 DOI: 10.1016/j.jfo.2020.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/12/2020] [Accepted: 08/24/2020] [Indexed: 11/21/2022]
Abstract
Visual rehabilitation in keratoconus is a challenge, notably because of the significant irregular astigmatism and optical aberrations that it induces. Many surgical techniques have been developed in addition to, or in the case of failure of, spectacles and rigid gas permeable contact lenses: intracorneal ring segments, intraocular lenses, excimer laser and, as a last resort, keratoplasty. Excimer laser photoablates the cornea, allowing remodeling of its surface. There are various treatment modes (wavefront-optimized, wavefront-guided and topography-guided), allowing performance of a customized treatment if needed. Its use in keratoconus has been described since the 2000s, alone or in combination with other procedures. For example, the combination of photoablation and corneal cross linking, a technique that increases corneal rigidity and in so doing can slow or even stop the progression of keratoconus, proved its efficacy and safety in many studies, and various protocols have been described. A triple procedure, including intracorneal ring segments, excimer laser and cross linking, has also given some very promising results in progressive keratoconus, providing a significative improvement in visual acuity and topographic data. The combination of excimer laser and intraocular lenses remains a poorly explored lead that might provide some satisfactory results. The objective of this review is to summarize the recent data on excimer laser in keratoconus management.
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Trinh L, Bouheraoua N, Roman S, Auclin F, Labbé A, Baudouin C. Excimer laser programming of refractive astigmatism vs. anterior corneal astigmatism in the case of ocular residual astigmatism (ORA). J Fr Ophtalmol 2020; 44:189-195. [PMID: 33358474 DOI: 10.1016/j.jfo.2020.04.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine whether manifest refractive astigmatism (RA) or anterior corneal astigmatism (CA) is the best value for excimer laser programming in cases of ocular residual astigmatism (ORA). PATIENTS AND METHODS Patients who had undergone LASIK surgery with a disagreement between manifest refractive and corneal cylinder (ocular residual astigmatism ORA)>0.75 D were included retrospectively in this study. We calculated target induced astigmatism vector (TIA), surgically induced astigmatism vector (SIA), difference vector between the astigmatism correction programmed in the excimer laser and refractive astigmatism (DVRA), difference vector between the astigmatism correction programmed in the excimer laser and corneal astigmatism (DVCA) and difference vector between TIA and SIA (DV), by the Alpins method. Vectorial differences between DV and DVRA, and between DV and DVCA, were then calculated to determine whether RA or CA was closest to the ideal cylinder for laser programming. RESULTS Of a total of 104 eyes undergoing LASIK, 22 eyes of 12 patients (21.1%) had an ORA>0.75 D and were included. Mean ORA was 0.9±0.2 D and mean postoperative subjective cylinder was 0.45 D. The DV-DVRA difference vector was 0.57±0.2 D, and the DV-DVCA difference vector was 0.86±0.4 D (P=0.02). RA was closer than CA to the ideal astigmatism correction. CONCLUSION In cases of discrepancy between manifest astigmatism and corneal astigmatism, correction of manifest refractive astigmatism seems to give a better refractive result.
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Affiliation(s)
- L Trinh
- CHNO des Quinze-Vingts, IHU Foresight, Inserm-DGOS CIC 1423, 28, rue de Charenton, 75012 Paris, France.
| | - N Bouheraoua
- CHNO des Quinze-Vingts, IHU Foresight, Inserm-DGOS CIC 1423, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, Inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - S Roman
- CHNO des Quinze-Vingts, IHU Foresight, Inserm-DGOS CIC 1423, 28, rue de Charenton, 75012 Paris, France
| | - F Auclin
- CHNO des Quinze-Vingts, IHU Foresight, Inserm-DGOS CIC 1423, 28, rue de Charenton, 75012 Paris, France
| | - A Labbé
- CHNO des Quinze-Vingts, IHU Foresight, Inserm-DGOS CIC 1423, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, Inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - C Baudouin
- CHNO des Quinze-Vingts, IHU Foresight, Inserm-DGOS CIC 1423, 28, rue de Charenton, 75012 Paris, France; Sorbonne Université, Inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
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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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Heralgi MM, Kavitha V, Dwivedi M, Preethi V, Roopasree BV, Rajashekar J, Deokar A. Study of change in contrast sensitivity in relation to depth of ablation after wavefront optimized myopic laser-assisted in situ keratomileusis. Indian J Ophthalmol 2020; 68:2975-2980. [PMID: 33229680 PMCID: PMC7856953 DOI: 10.4103/ijo.ijo_1399_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The aim of this work was to study the change in contrast sensitivity (CS) in relation to depth of stromal ablation after wavefront-optimized (WFO) myopic laser in situ keratomileusis (LASIK). Methods: This was as prospective, longitudinal, comparative study. The study participants were divided into two groups: Group 1 ≤50 μ ablation depth; 60 eyes and group 2 >50 μ ablation depth; 60 eyes. All underwent WFO LASIK. Uncorrected and corrected distance visual acuity (UDVA and CDVA) and CS were measured preoperatively and postoperatively at 1 week, 2 weeks, and 2 and 6 months. Two-way repeated-measures analysis of variance (ANOVA), Unpaired t test and one-way repeated measures ANOVA were used to test differences across time periods within each treatment group. A value of P < 0.05 was considered as statistically significant. Results: The mean ablation depths in groups 1 and 2 were 39.30 μ ± 7.22 μ and 69.90 μ ± 12.09 μ, respectively; the maximum depth was 94.62 μ. In group 1, the preoperative mean CS was 1.91 ± 0.07, which improved postoperatively at 1 week (1.93 ± 0.06) and remained stable in subsequent follow-ups (1.94 ± 0.05). In group 2, the mean CS preoperatively was 1.87 ± 0.12, which postoperatively at 1 week and 6 months were 1.93 ± 0.07 and 1.94 ± 0.03, respectively (P < 0.05). Between the groups, preoperative CS was significantly different (P = 0.04), but the change in CS post-LASIK was insignificant (P > 0.05). Conclusion: There was a significant improvement in CS after WFO myopic LASIK in all patients irrespective of ablation depth (up to 94.62 μ).
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Affiliation(s)
- Mallikarjun M Heralgi
- Cornea and Refractive Surgery Department, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - V Kavitha
- Department of Pediatric Ophthalmology, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Manisha Dwivedi
- Cornea and Refractive Surgery Department, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - V Preethi
- Sankara Eye Hospital, Harakere, Shimoga, Karnataka, India
| | - B V Roopasree
- Cornea and Refractive Surgery Department, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - J Rajashekar
- Cornea and Refractive Surgery Department, Sankara Eye Hospital, Shimoga, Karnataka, India
| | - Ankit Deokar
- Cornea and Refractive Surgery Department, Sankara Eye Hospital, Shimoga, Karnataka, India
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Brunson PB, Mann Ii PM, Mann PM, Potvin R. Clinical Outcomes After Topography-Guided Refractive Surgery in Eyes with Myopia and Astigmatism - Comparing Results with New Planning Software to Those Obtained Using the Manifest Refraction. Clin Ophthalmol 2020; 14:3975-3982. [PMID: 33235434 PMCID: PMC7680153 DOI: 10.2147/opth.s280959] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/29/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare clinical outcomes from topography-guided laser refractive surgery based on new planning software to outcomes based on using the manifest refraction. Design Single site, two-arm, retrospective chart review. Methods Clinical outcomes at a single site after topography-guided LASIK using the Wavelight excimer laser were evaluated, with a target postoperative follow-up time of 90 days. Eligible eyes were those that received on-label topography-guided treatment of myopia or myopic astigmatism with correction based on either the manifest refraction or results from the Phorcides Analytical Engine (PAE). Measures analyzed included the uncorrected (UDVA) and best-corrected (CDVA) distance visual acuity, the magnitude of refractive cylinder after surgery, the refractive error and changes from preoperative CDVA. Results The study included 115 eyes in the PAE group and 133 eyes in the Manifest group. Significantly more eyes in the PAE group had a CDVA of 20/15 or better (p = 0.05) and a UDVA of 20/15 or better (p = 0.05). Significantly more eyes in the Manifest group had a UDVA of 20/25 or worse (13/133 vs 1/115 in the PAE group, p = 0.002). There were significantly more eyes in the PAE group with no postoperative refractive cylinder (90% vs 77% in the Manifest group, p = 0.004). No eye in either group had a postoperative CDVA a line or worse than their preoperative CDVA. Three eyes in the Manifest group and no PAE eyes have had subsequent enhancement surgery. Conclusion Mean results for postoperative refractive astigmatism, CDVA and UDVA were similar between the groups, but the clinical outcomes for the PAE group appeared less variable, with more eyes having no refractive astigmatism and a higher percentage of eyes having 20/15 or better CDVA and UCVA. The objective nature of the PAE is an advantage.
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Wallerstein A, Gauvin M, Cohen M. Targeting Anterior Corneal Astigmatism With Topography-Guided Ablation Ignores Ocular Residual Astigmatism, Resulting in Inferior Outcomes. J Refract Surg 2020; 36:63-64. [PMID: 31917855 DOI: 10.3928/1081597x-20191210-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wallerstein A, Gauvin M, Qi SR, Cohen M. Effect of the Vectorial Difference Between Manifest Refractive Astigmatism and Anterior Corneal Astigmatism on Topography-Guided LASIK Outcomes. J Refract Surg 2020; 36:449-458. [DOI: 10.3928/1081597x-20200609-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/05/2020] [Indexed: 11/20/2022]
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Shetty N, Dadachanji Z, Narasimhan R, Kundu G, Khamar P, Ahuja P, Kumar V, Kumar V, Shetty R, Nuijts RMMA, Sinha Roy A. Status of Residual Refractive Error, Ocular Aberrations, and Accommodation After Myopic LASIK, SMILE, and TransPRK. J Refract Surg 2019; 35:624-631. [PMID: 31610003 DOI: 10.3928/1081597x-20190916-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/16/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze residual refractive error, ocular aberrations, and visual acuity (VA) during accommodation simultaneously with ocular aberrometry in eyes after laser-assisted in situ keratomileusis (LASIK), small incision lenticule extraction (SMILE), and transepithelial photorefractive keratectomy (TransPRK). METHODS Ocular aberrometry (Tracey Technologies, Houston, TX) was performed 3 months after LASIK (n = 95), SMILE (n = 73), and TransPRK (n = 35). While measuring the aberrations, VA was measured at distance (20 ft), intermediate (60 cm), and near (40 cm) targets. The examinations were done monocularly. A parallel group of age-matched normal eyes (n = 50) with 20/20 Snellen distance VA also underwent aberrometry. RESULTS Distribution of residual spherical error of LASIK eyes matched the normal eyes the best, followed by SMILE and TransPRK. However, the distribution of cylindrical error of the SMILE eyes was distinctly different from the rest (P < .05). The SMILE eyes tended to be undercorrected by approximately 0.25 diopters (D) on average at all reading targets compared to LASIK eyes (P < .05). The undercorrection was greater when the magnitude of the preoperative cylinder exceeded 0.75 D (P < .05). The VA of LASIK and SMILE eyes was similar to normal eyes at all targets, but the TransPRK eyes were marginally inferior (P < .05). Only the ocular defocus changed differentially between the study groups during accommodation and the magnitude of change was least for TransPRK eyes (P < .05). However, postoperative near and intermediate accommodation of LASIK eyes were similar to normal eyes, followed by SMILE eyes and then TransPRK eyes. CONCLUSIONS The refractive and aberrometric status of the LASIK eyes was closest to the normal eyes. The SMILE procedure may benefit from slight overcorrection of the preoperative refractive cylinder. [J Refract Surg. 2019;35(10):624-631.].
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Zhang Y, Chen Y. A Randomized Comparative Study of Topography-Guided Versus Wavefront-Optimized FS-LASIK for Correcting Myopia and Myopic Astigmatism. J Refract Surg 2019; 35:575-582. [DOI: 10.3928/1081597x-20190819-01] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/19/2019] [Indexed: 11/20/2022]
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