Q-value customized versus wavefront-optimized ablation in femtosecond laser-assisted LASIK for myopia and myopic astigmatism: a prospective contralateral comparative study

Magdi Mohammad Mostafa, Hazem Abdelmotaal, Khaled Abdelazeem, Islam Goda, Mahmoud Abdel-Radi, Magdi Mohammad Mostafa, Hazem Abdelmotaal, Khaled Abdelazeem, Islam Goda, Mahmoud Abdel-Radi

Abstract

Background: Corneal refractive surgery for myopia results in an oblate shift with increased postoperative aberrations inversely affecting the quality of vision. Aspheric ablation profiles have been introduced to minimize such a problem. The aim of this study was to compare changes in corneal asphericity, central and mid-peripheral pachymetry between the Q-value customized and the wavefront-optimized (WFO) ablation profiles.

Methods: A prospective, comparative non-randomized fellow eye study was conducted. Eighty eyes of 40 eligible patients underwent femtosecond laser-assisted laser in situ keratomileusis for myopia and myopic astigmatism. In each patient, the more myopic eye was included in the custom-Q ablation experimental group and the other less myopic eye was included in the WFO control group. For the custom-Q group, the target asphericity was set to the preoperative Q-value. Corneal asphericity, central and mid-peripheral pachymetric changes and the root mean square of corneal higher-order aberrations (RMSh) were assessed 6 months following surgery. Visual and refractive outcomes were also evaluated in both platforms 6 months postoperatively.

Results: The mean preoperative refractive spherical equivalent was significantly more myopic in the custom-Q group than in the WFO group (P = 0.001). The mean Q-value changed from - 0.2 ± 0.1 to 0.6 ± 0.7 and from - 0.2 ± 0.1 to 0.4 ± 0.5 in the custom-Q and WFO groups, respectively. The oblate shift in corneal asphericity was not significantly different between both treatment groups (P = 0.094). The mean ablation depth at the pupillary center was significantly greater in the custom-Q group (P = 0.011), while there was no significant difference at the mid-peripheral pachymetry (P = 0.256). The RMSh significantly increased in both treatment profiles (P < 0.001) with no significant difference between the two groups (P = 0.06). The uncorrected distance visual acuity (UDVA) and the manifest refraction spherical equivalents (MRSE) significantly improved in both treatment groups (P < 0.001).

Conclusions: The custom-Q treatment profile with target asphericity set at the preoperative Q-value achieved comparable outcomes vs. the WFO profile in terms of postoperative corneal asphericity and mid-peripheral pachymetry despite the greater amount of ablation, the smaller optical zone, and the resulting increase in postoperative corneal flattening in the custom-Q group. Trial registration (Clinicaltrials.gov): NCT04738903, 4 February 2021- Retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04738903.

Keywords: Corneal asphericity; Custom Q; Q-value; Wavefront-optimized.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Visual and refractive outcomes in the custom-Q group 6 months postoperatively. a Cumulative postoperative Snellen UDVA as compared to the cumulative preoperative Snellen CDVA. b Difference between preoperative and postoperative CDVA in terms of lost or gained lines. c Proximity of the achieved to the intended spherical equivalent. d Preoperative and postoperative refractive cylinder. CDVA, corrected distance visual acuity; UDVA, uncorrected distance visual acuity
Fig. 2
Fig. 2
Visual and refractive outcomes in the wavefront-optimized group 6 months postoperatively. a Cumulative postoperative Snellen UDVA as compared to the cumulative preoperative Snellen CDVA. b Difference between preoperative and postoperative CDVA in terms of lost or gained lines. c Proximity of the achieved to the intended spherical equivalent. d Preoperative and postoperative refractive cylinder. CDVA, corrected distance visual acuity; UDVA, uncorrected distance visual acuity
Fig. 3
Fig. 3
Proximity of the achieved to the preoperative Q-value in both treatment groups (taking the preoperative Q-value as the target asphericity for the custom-Q group). a All manifest refractive spherical equivalent (MRSE) subgroups; b Low myopia subgroup; c Moderate myopia subgroup; d High myopia subgroup

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