One-Year Outcomes from a Prospective, Randomized, Eye-to-Eye Comparison of Wavefront-Guided and Wavefront-Optimized LASIK in Myopes

Objective: To compare wavefront (WF)-guided and WF-optimized LASIK in myopes. Design: Prospective, randomized, eye-to-eye study. Participants: A total of 72 eyes of 36 participants with myopia with or without astigmatism. Methods: Participants were randomized to receive WF-guided or WF-optimized LASIK with the WaveLight Allegretto Eye-Q 400-Hz excimer laser platform (Alcon, Inc., Huenberg, Switzerland). LASIK flaps were created using the 150-kHz IntraLase iFS (Abbott Medical Optics, Santa Ana, CA). Evaluations included measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), <5% and <25% contrast sensitivity, and WF aberrometry. Patients also completed a validated questionnaire detailing symptoms on a quantitative scale. Main Outcome Measures: Safety, efficacy, predictability, refractive error, UDVA, CDVA, contrast sensitivity, and higher-order aberrations (HOAs). Results: The frequency with which the WF-guided and WF-optimized groups achieved postoperative UDVA of >= 20/16 or >= 20/20 and the frequency with which the groups lost 1 or 2 or more lines or maintained their preoperative CDVA were not statistically different from each other (all P > 0.05). The frequency with which the WF-guided group attained a refractive error within +/- 0.25 diopters of emmetropia was higher than in the WF-optimized group (67.6%, 95% confidence interval [CI], 50.4-84.8 vs. 41.2%, 95% CI, 23.2-59.2; P = 0.03). The WF-guided group's mean UDVA was better than the WF-optimized group's UDVA by approximately 1 Early Treatment Diabetic Retinopathy Study line (-0.17 +/- 0.11 logarithm of the minimum angle of resolution [logMAR], slightly <20/12 Snellen vs. -0.13 +/- 0.12, slightly >20/16; P = 0.05). There were no statistically significant differences in contrast sensitivity, astigmatism, coma, or higher-order root mean square error between the groups (all P > 0.05), but the WF-guided group had less trefoil compared with the WF-optimized group (0.14 +/- 0.07 vs. 0.20 +/- 0.09; P < 0.01). There were no statistically significant differences in subjective parameters between the groups (all P > 0.05). Conclusions: Wavefront-guided and WF-optimized LASIK using the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform provide similar results in myopic patients; however, the WF-guided approach may yield small gains in visual acuity, predictability, and HOAs. (C) 2013 by the American Academy of Ophthalmology.