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Coscarelli S, Rodrigues P, Rocha G, Torquetti L. Preliminary results of a new intrastromal corneal ring segment as a tissue saving procedure in photorefractive keratectomy to correct moderate to high myopia. Int J Ophthalmol 2020; 13:1955-1960. [PMID: 33344196 DOI: 10.18240/ijo.2020.12.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/27/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the clinical results after implantation of a new intrastromal corneal ring segment (ICRS) associated with photorefractive keratectomy (PRK) to correct high myopia (HM) patients with thin corneas. METHODS We evaluated 42 eyes of 23 HM patients that had ICRS implantation followed by PRK. The mean age of patients was 29.1±7.12y (range 18 to 40 years old). Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), keratometry, spherical equivalent, pachymetry, and aberrometry were compared using ANOVA with repeated measurements evaluated preoperatively and at last follow-up visit after the procedures. The refractive predictability and simulated/real corneal ablation were also assessed. RESULTS The mean follow-up time after PRK was 6.8±1.6mo. The mean preoperative UCVA improved from 20/800 preoperative to 20/100 after ICRS and 20/35 after PRK. The mean preoperative BCVA was 20/25 (range from 20/30 to 20/20) and remained unchanged after ICRS implantation. Following the PRK the mean BCVA was 20/25 (range from 20/30 to 20/20). The mean spherical equivalent decreased from -7.25±1.12 (range -5.00 to -9.00) preoperatively to -3.32±1.0 (range -2.00 to -5.00) postoperatively (P<0.001) after ICRS implantation and decreased from -2.44±1.51 preoperatively to 0.32±0.45 (range -0.625 to 0.875) postoperatively (P<0.001) after PRK. The change in BCVA and topographic astigmatism was statistically significant (P<0.0001). CONCLUSION ICRS in HM associated with PRK can be a tissue saving procedure and an alternative surgical option for correction of moderate to high myopia.
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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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Wallerstein A, Kam JWK, Gauvin M, Adiguzel E, Bashour M, Kalevar A, Cohen M. Refractive, visual, and subjective quality of vision outcomes for very high myopia LASIK from - 10.00 to - 13.50 diopters. BMC Ophthalmol 2020; 20:234. [PMID: 32552787 PMCID: PMC7302155 DOI: 10.1186/s12886-020-01481-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate laser-assisted in situ keratomileusis (LASIK) outcomes, subjective quality of vision (QoV) and patient satisfaction in eyes with very high myopia (VHM) above − 10.00 diopters (D). Methods Consecutive myopic and myopic-astigmatism eyes with spherical equivalent (SEQ) ranging between − 10.00 to − 13.50 D underwent LASIK with the WaveLight® Allegretto Wave® Eye-Q 400 Hz excimer laser. Treatment accuracy, efficacy, safety, stability, cylinder vectors, and higher-order aberrations were evaluated, together with subjective QoV and night vision disturbances (NVDs). Results 114 eyes had a preoperative SEQ of − 11.02 ± 0.81 D, with a median follow-up of 24 months. A total of 72, 84, and 94% of eyes were within ± 0.50, ± 0.75 and ± 1.00 D of intended SEQ (R2 = 0.71). The efficacy index was 0.93 ± 0.20, with 51 and 81% of eyes achieving 20/20 and 20/25. The astigmatism correction index was 0.95 ± 0.33. The safety index was 1.05 ± 0.12. The average myopic regression was − 0.51 ± 0.38 D. Preoperative QoV scores improved significantly postoperatively (7.5 ± 0.8 vs. 9.1 ± 0.7; P < 0.001), with less NVDs (P < 0.001). Total, spherical and coma root mean square (RMS) postoperative ocular higher-order aberrations were 1.07 ± 0.34, 0.67 ± 0.25, and 0.70 ± 0.40 μm. Conclusions Very high myopia LASIK between − 10.00 to − 13.50 D is safe and results in good visual outcomes, with high patient satisfaction and a significant improvement in patient-reported QoV after surgery. Appropriately selected patients within this very high myopia group can be included as LASIK candidates.
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Affiliation(s)
- Avi Wallerstein
- Department of Ophthalmology, McGill University, Montreal, QC, Canada. .,LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada.
| | | | - Mathieu Gauvin
- Department of Ophthalmology, McGill University, Montreal, QC, Canada.,LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada
| | - Eser Adiguzel
- LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada
| | - Mounir Bashour
- LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada
| | - Ananda Kalevar
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Mark Cohen
- LASIK MD, 1250 Rene-Levesque Blvd W, MD Level, Montreal, QC, H3B 4W8, Canada.,Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
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Agarwal S, Thornell E, Hodge C, Sutton G, Hughes P. Visual Outcomes and Higher Order Aberrations Following LASIK on Eyes with Low Myopia and Astigmatism. Open Ophthalmol J 2018; 12:84-93. [PMID: 29997707 PMCID: PMC5997857 DOI: 10.2174/1874364101812010084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/18/2018] [Accepted: 05/14/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Laser-Assisted in situ Keratomileusis (LASIK) can induce corneal aberrations that can impact vision and patient satisfaction. Recent developments in laser technologies have helped minimise these aberrations. Objective: To assess the quality of vision and change in Higher-Order Aberrations (HOAs) following wavefront-optimized LASIK in low-myopic astigmatic patients. Methods: LASIK was performed on a total of 76 eyes in patients with myopia <4.0 D and cylinder <2.0 D using the WaveLight® EX500 excimer and FS200 femtosecond laser platform. Visual acuity, contrast sensitivity and HOAs were measured at 1 and 3 months postoperatively and compared to preoperative values. Subjective quality of vision was assessed pre- and postoperatively using a VF14 questionnaire. Results: Mean postoperative Spherical Equivalent (SE) was -0.09 ± 0.26 µm with 95% of patients within ± 0.5 D of attempted SE. Postoperative uncorrected distance visual acuity was 20/20 or better for 96% of patients. Contrast sensitivity increased against horizontal and vertical gratings at all spatial frequencies except for vertical gratings at 18 cycles/degree. Spherical aberration and total HOA increased by 0.085 µm and 0.13 µm respectively. The mean VF14 score increased from 89.2 ± 16.7% to 99 ± 1.4% postoperatively. Conclusion: LASIK performed using the WaveLight® EX500 excimer and WaveLight® FS200 laser platform provided improved contrast sensitivity and visual acuity with minimal introduction of HOAs, making it a suitable platform for low myopic astigmatic patients.
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Affiliation(s)
- Smita Agarwal
- Wollongong Eye Specialists, 13 Market st, Wollongong, Australia.,University of Wollongong, Northfields ave, Wollongong, Australia
| | - Erin Thornell
- Wollongong Eye Specialists, 13 Market st, Wollongong, Australia
| | - Chris Hodge
- Vision Eye Institute, 8-10 Woniora rd, Hurstville, Australia
| | | | - Paul Hughes
- Vision Eye Institute, 8-10 Woniora rd, Hurstville, Australia
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Kataoka T, Nishida T, Murata A, Ito M, Isogai N, Horai R, Kojima T, Yoshida Y, Nakamura T. Control-matched comparison of refractive and visual outcomes between small incision lenticule extraction and femtosecond laser-assisted LASIK. Clin Ophthalmol 2018; 12:865-873. [PMID: 29785082 PMCID: PMC5953304 DOI: 10.2147/opth.s161883] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose This retrospective case-matched study aimed to compare visual and refractive outcomes between small incision lenticule extraction (SMILE) and LASIK. Patients and methods Patients who underwent SMILE (34 eyes of 23 patients) or LASIK (34 eyes of 24 patients) were enrolled and matched according to preoperative manifest refractive spherical equivalents. The mean preoperative manifest refractive spherical equivalent was −4.69±0.6 and −4.67±0.64 D in the SMILE and LASIK groups, respectively. The safety, efficacy, and predictability were compared 3 months after surgery. Changes in corneal refractive power from the center to peripheral points and their maintenance ratios were analyzed and compared between the two groups. Results In the SMILE and LASIK groups, 82.4% and 85.3% of patients, respectively, achieved 20/13 or better uncorrected distance visual acuity (p=1.00). There were no eyes that lost two or more lines of corrected distance visual acuity in either group. The maintenance ratios of corneal refractive power changes at the peripheral points in the SMILE group were significantly higher than those in the LASIK group (p<0.05). Conclusion Both groups achieved similar high efficacy and safety. SMILE surgery resulted in higher refractive power correction in the peripheral cornea than LASIK surgery.
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Affiliation(s)
| | | | | | | | | | | | - Takashi Kojima
- Nagoya Eye Clinic, Nagoya, Japan.,Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
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Effect of Cap-Lenticule Diameter Difference on the Visual Outcome and Higher-Order Aberrations in SMILE: 0.4 mm versus 1.0 mm. J Ophthalmol 2017; 2017:8259546. [PMID: 29270316 PMCID: PMC5705886 DOI: 10.1155/2017/8259546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/29/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the effect of cap-lenticule diameter difference (CLDD) on the visual outcome and higher-order aberrations (HOAs) of small-incision lenticule extraction (SMILE). Methods A total of 132 patients who had bilateral SMILE for myopia or myopic astigmatism were included. The CLDD was 0.4 mm in 54 patients (group 1) and 1.0 mm in 78 patients (group 2). The refractive parameters, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and HOAs were determined preoperatively and during six months follow-up. Results Group 1 had better CDVA (in logMAR) compared to group 2 at day 1 (−0.07 ± 0.07 versus 0.04 ± 0.07, resp.; p < 0.001) and week 1 (−0.07 ± 0.07 versus –0.04 ± 0.07, resp.; p = 0.001). The visual acuity improved more in group 1 than in group 2. The UDVA (in logMAR) was 0.07 ± 0.07 and 0.29 ± 0.09 at day 1 (p < 0.001) and −0.08 ± 0.07 and −0.06 ± 0.06 at six months (p = 0.038) in group 1 and group 2, respectively. Group 1 was associated with significantly less induction of HOAs (0.24 ± 0.08 μm and 0.32 ± 0.26 μm, resp.; p = 0.002). Conclusions In SMILE, 0.4 mm CLDD is associated with better visual outcome and less induction of HOAs than 1.0 mm. Narrow CLDD should be considered in SMILE to increase the visual acuity particularly in the early postoperative period.
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Zhao PF, Li SM, Lu J, Song HM, Zhang J, Zhou YH, Wang NL. Effects of higher-order aberrations on contrast sensitivity in normal eyes of a large myopic population. Int J Ophthalmol 2017; 10:1407-1411. [PMID: 28944201 DOI: 10.18240/ijo.2017.09.13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 04/17/2017] [Indexed: 12/28/2022] Open
Abstract
AIM To study the relation between higher-order aberrations (HOAs) and contrast sensitivity (CS) in normal eyes among a population of laser in situ keratomileusis (LASIK) candidates. METHODS In 6629 eyes of 3315 LASIK candidates, CS were measured under dark environment at the spatial frequencies of 1.5, 3, 6, 12 and 18 cycles per degree (c/d), respectively, using an Optec 6500 visual function tester. Meanwhile, ocular HOAs were measured for a 6.0 mm pupil with a Hartmann-Shack wavefront analyzer. RESULTS In the study, the subjects with an average spherical equivalent of -4.86±2.07 D were included. HOAs decreased from the third to the sixth order aberrations with predominant aberrations of third-order coma, trefoil and fourth-order spherical aberration. At low and moderate spatial frequencies, CS was negatively correlated with the third-order coma and trefoil aberrations, and decreased with increasing Z31, but increased with increasing Z3-3 and Z5-1. At high spatial frequencies, CS decreased with increasing Z3-3 and increased with increasing Z5-1. CONCLUSION At a large pupil size of 6.0 mm, the third-order aberrations, but not the total aberrations, are the main factors affecting CS. Vertical coma is negatively correlated with CS.
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Affiliation(s)
- Peng-Fei Zhao
- Ophthalmic Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing 100730, China
| | - Shi-Ming Li
- Ophthalmic Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing 100730, China
| | - Jing Lu
- Department of Ophthalmology, Affiliated Hospital of Hebei Medical University, Baoding 100730, Hebei Province, China
| | - Hong-Min Song
- College of Applied Arts and Science, Beijing Union University, Beijing 100191, China
| | - Jing Zhang
- Ophthalmic Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing 100730, China
| | - Yue-Hua Zhou
- Ophthalmic Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing 100730, China
| | - Ning-Li Wang
- Ophthalmic Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Lab, Beijing 100730, China
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Effect of iris registration on outcomes of FEMTOLASIK for myopia and myopic astigmatism. Int Ophthalmol 2017; 38:2077-2087. [PMID: 28875250 DOI: 10.1007/s10792-017-0703-3] [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: 09/09/2016] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the visual and refractive outcomes after FEMTOLASIK with and without iris registration. METHODS In this randomized, prospective, comparative, contralateral eye study, 118 eyes of 59 patients with myopia and myopic astigmatism underwent LASIK using the Femto LDV femtosecond laser (160 µm) and the MEL80 with or without iris registration. For each patient, iris registration FEMTOLASIK was performed on one eye and non-iris registration FEMTOLASIK was performed on the other eye, assigned at random. Patients were evaluated before and 12 months. Uncorrected visual acuity, best-corrected visual acuity, manifest refraction, contrast sensitivity, and higher-order aberrations (HOAs) were evaluated. RESULTS At 12 months, the mean UDVA was 0.002 ± 0.07 logMAR (20/19) in iris registration eyes and 0.00 ± 0.06 logMAR (20/24) in non-iris registration eyes (P = 0.9). 61% of iris registration eyes and 71.2% of non-iris registration eyes achieved a UDVA of 20/20 or better (P = 0.31); 98.3% of eyes with the iris registration FEMTOLASIK and 94.9% with the non-iris registration FEMTOLASIK were within ±0.50 D from emmetropia (P = 0.71). No statistically significant difference was found in postoperative contrast sensitivity between groups at 3, 6, 12, or 18 cycles/degree (P > 0.05). There was significant increase in total HOA root mean square in two groups. The mean error magnitude of surgically induced astigmatism 12 months postoperatively was -0.33 in iris registration eyes and -0.24 in the non-iris registration eyes (P = 0.36). CONCLUSIONS FEMTOLASIK with and without iris registration provides similar results in myopic and myopic astigmatism patients.
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Chen X, Wang Y, Zhang J, Yang SN, Li X, Zhang L. Comparison of ocular higher-order aberrations after SMILE and Wavefront-guided Femtosecond LASIK for myopia. BMC Ophthalmol 2017; 17:42. [PMID: 28388896 PMCID: PMC5384151 DOI: 10.1186/s12886-017-0431-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 03/31/2017] [Indexed: 11/17/2022] Open
Abstract
Background To compare changes in higher-order aberrations (HOAs) following small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG FS-LASIK), and to investigate correlations between preoperative spherical equivalence (SE) and components of HOAs affecting visual quality. Methods Sixty-five myopic eyes from 38 patients were enrolled in the study retrospectively, either having undergone SMILE or WFG FS-LASIK. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and individual Zernike coefficients of 3rd- to 6th-order HOAs were measured before and 3 months after the surgeries and were compared using the Mann-Whitney test or Student’s t-test. Additional generalized estimating equation analyses (GEE) were used to control for within-subject biases in individual Zernike coefficients between the right and left eyes of the same patients. Results There was no significant difference in UDVA or CDVA after WFG FS-LASIK (Mean ± SD: −0.02 ± 0.07 and −0.04 ± 0.22 respectively, in logMAR) and after SMILE (−0.01 ± 0.06 and −0.04 ± 0.04 respectively). However, greater vertical coma aberration was found after SMILE (p = 0.036). Preoperative SE was correlated to induced horizontal coma (r = −0.608, p = 0.001) in WFG FS-LASIK, and correlated to induced vertical coma (r = −0.459, p = 0.003) in SMILE. Conclusions Both SMILE and WFG FS-LASIK can achieve planned visual outcomes in correcting myopia and myopic astigmatism. However, higher vertical coma was shown in SMILE than WFG FS-LASIK which might be a potentially impact factor for patients’ vision under certain lighting conditions and needs further investigation.
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Affiliation(s)
- Xiaoqin Chen
- Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No 4. Gansu Rd, Heping District, Tianjin, 300020, China
| | - Yan Wang
- Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No 4. Gansu Rd, Heping District, Tianjin, 300020, China.
| | - Jiamei Zhang
- Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No 4. Gansu Rd, Heping District, Tianjin, 300020, China
| | - Shun-Nan Yang
- Vision Performance Institute, Pacific University College of Optometry, Forest Grove, OR, USA
| | - Xiaojing Li
- First Hospital of Qinhuangdao, Qinhuangdao, Hebei, China
| | - Lin Zhang
- Tianjin Eye Hospital & Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Medical University, No 4. Gansu Rd, Heping District, Tianjin, 300020, China
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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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Moussa S, Dexl AK, Krall EM, Arlt EM, Grabner G, Ruckhofer J. Visual, aberrometric, photic phenomena, and patient satisfaction after myopic wavefront-guided LASIK using a high-resolution aberrometer. Clin Ophthalmol 2016; 10:2489-2496. [PMID: 28003739 PMCID: PMC5161390 DOI: 10.2147/opth.s108002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the visual, refractive, and aberrometric outcomes as well as the level of patient satisfaction and photic phenomena after myopic laser in situ keratomileusis (LASIK) surgery using wavefront-guided (WFG) ablations based on measurements obtained with a high-resolution aberrometer. Patients and methods This study was a prospective analysis including 253 eyes of 127 patients (aged between 19 years and 54 years) undergoing WFG LASIK using the STAR S4 IR Excimer Laser System combined with the iDesign System and iFS Femtosecond Laser. Visual, refractive, and aberrometric outcomes during a 2-month follow-up as well as patient satisfaction and photic phenomena were evaluated by means of a questionnaire. Results A total of 85% (215/253) and 99% (251/253) of eyes achieved a postoperative (Postop) uncorrected distance visual acuity of 20/16 and 20/20, respectively, and all eyes achieved an uncorrected distance visual acuity of 20/25. Postop spherical equivalent values were within ±0.25 D and ±0.50 D in 97% and 100% of eyes, respectively. Likewise, manifest cylinder was <0.25 D in 97% (245/253) of eyes. A statistically significant reduction was found in the total root mean square (P<0.001) and in the level of primary spherical aberration (P=0.001). Postop difficulties related to vision were graded as minimal, with low levels of photic phenomena and high levels of patient satisfaction. The level of difficulty to perform daily activities and the level of glare perceived by patients while driving car were significantly decreased (P<0.001). Conclusion WFG LASIK surgery using the technology evaluated is predictable and effective for the correction of myopia and leads to high levels of patient satisfaction.
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Affiliation(s)
- Sarah Moussa
- Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alois K Dexl
- Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eva M Krall
- Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eva M Arlt
- Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Günther Grabner
- Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Josef Ruckhofer
- Department of Ophthalmology, Paracelsus Medical University Salzburg, Salzburg, Austria
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12
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Valentina BS, Ramona B, Speranta S, Calin T. The influence of optical aberrations in refractive surgery. Rom J Ophthalmol 2015; 59:217-222. [PMID: 29450310 PMCID: PMC5712942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2015] [Indexed: 06/08/2023] Open
Abstract
Optical aberrations lead to defects in image-forming, the image obtained being imperfect and thereby decreasing the quality of vision. When an optic system is not perfect, as happens with the eye, the rays of light that pass through the system produce optical aberrations. The purpose of this review is to describe optical aberrations and their impact on vision and how refractive surgery outcomes are influenced by them. The main optical aberrations of the eye are as follows: spherical aberration, chromatic aberration, oblique astigmatism and high order aberrations. When the patient undergoes various types of surgeries (cataract surgery, corneal refractive surgery) the properties of the eye change and the eye doctor must take into account the correction of optical aberrations to improve vision quality. Abbreviations: LASIK (laser in situ keratomileusis), PRK (photorefractive keratectomy), UDVA (uncorrected distance visual acuity), SA (spherical aberrations), HOA (higher-order aberrations), RMS (root mean square).
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Abstract
BACKGROUND Within less than 30 years refractive laser surgery has been developed from an experimental technique to one of the most frequently applied procedures in ophthalmology worldwide. RESULTS Regarding the success rate of refractive results, myopia correction has reached a level (95% within ± 0.5 D) that is comparable to manifest refraction so that there is not much room for improvement. The most recently developed technique is femtosecond laser lenticule extraction which was introduced in 2007 in Germany. Early clinical results were very promising but the awaited bilateral comparative studies are still lacking. Although new laser types that will be able to provide improved profiles are on the horizon, the problem of reoperations has not yet been solved. Topography-guided ablation is notoriously plagued by undercorrection so that topography-guided treatment is planned as a two step-procedure. The reason for the undercorrection is the leveling effect of the epithelium. PERSPECTIVES The evolution of refractive surgery has slowed down during the last years, however, some important innovations are at the advent.
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Affiliation(s)
- T Seiler
- Institut für Refraktive und Ophthalmo-Chirurgie (IROC), Stockerstr. 37, 8002, Zürich, Schweiz,
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