Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided and Wavefront-Optimized Laser in Situ Keratomileusis

PURPOSE: To compare outcomes in wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) to high-resolution wavefront-guided (WFG) LASIK. DESIGN: Randomized, fellow eye controlled, clinical trial. METHODS: A total of 200 eyes of 100 patients with myopia or compound myopic astigmatism undergoing bilateral LASIK between October 2015 and February 2017 underwent wavefront-optimized (WFO) LASIK in 1 eye and wavefront-guided (WFG) LASIK in the fellow eye. Each eye was evaluated for uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), contrast sensitivity, refractive error, and wavefront aberrometry. Outcome measurement primarily UDVA at 12 months. Secondary outcomes were safety, predictability, stability, refractive error, CDVA, contrast sensitivity, and higher-order aberrations at 12 months. RESULTS: WFG LASIK had higher levels of supervision and better contrast sensitivity compared to WFO. Both types had excellent postoperative UDVA results, without a significant difference in either mean UDVA or frequency of achieving a specified UDVA, for example, 20/16 or better (all P > 0.05). The mean gain in lines of CDVA was significantly higher in the WFG than in the WFO group (0.80 +/- 0.75 vs 0.62 +/- 0.72, respectively; P = 0.04). The WFG cohort had significantly better contrast sensitivity for mean and frequency of achieving > 20/40 for < 5% low-contrast sensitivity (37.1%; 95% confidence interval [CI], 27.5-46.7 vs 24.7%; 95% CI, 16.2-33.3, respectively; P = 0.01) and > 20/32 for < 25% low-contrast sensitivity (10.3%; 95% CI, 4.3-16.4 vs 4%, respectively; 95% CI, 0.0-8.1, respectively; P = 0.04). The WFO group had a significantly higher frequency of < 0.25 diopters (D) of refractive astigmatism at 12 months (82.5%; 95% CI, 75.0-90.0; vs 72.1%, respectively; 95% CI, 63.2-81.2; P = 0.02) but not <0.50 D (95.6%; 95% CI, 91.9-99.8; vs 96.9, respectively; 95% CI, 93.5-100; P = 0.61). The WFG group was significantly closer to emmetropia for both sphere and spherical equivalents at all time points. Trefoil was significantly lower in the WFG group and was also significantly lower than preoperative measurements. CONCLUSIONS: Wavefront-optimized and high- resolution wavefront-guided LASIK achieve excellent visual outcomes. Nonetheless, treatments based on a high-resolution aberrometer appear to offer superior results in some regards. (C) 2019 Elsevier Inc. All rights reserved.