Comparison of outcomes after topography-modified refraction versus wavefront-optimized versus manifest topography-guided LASIK

Jaeryung Kim, Sung-Ho Choi, Dong Hui Lim, Gil-Joong Yoon, Tae-Young Chung, Jaeryung Kim, Sung-Ho Choi, Dong Hui Lim, Gil-Joong Yoon, Tae-Young Chung

Abstract

Background: To compare the outcomes of myopia and myopic astigmatism corrected with topography-modified refraction laser in situ keratomileusis (TMR-LASIK), wavefront-optimized (WFO) LASIK, and topography-guided (TG) LASIK with a correction target based on the manifest refraction (manifest TG-LASIK).

Methods: This observational, retrospective cohort study included patients who underwent LASIK using the WaveLight® EX500 excimer laser to correct myopia and myopic astigmatism between August 2016 and July 2017. Patients who underwent TMR-LASIK (85 patients), WFO-LASIK (70 patients), or manifest TG-LASIK (40 patients) were enrolled, and only one eye from each patient was analyzed. All participants underwent measurement of the uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (BCVA), manifest refraction, vector analysis of astigmatic change, corneal topography, and corneal wavefront analysis at baseline and at every posttreatment visit.

Results: Three months postoperatively, a UDVA of 0.0 logMAR or better and manifest refraction spherical equivalent (MRSE) within ±0.5 diopters (D) did not differ across the TMR-, WFO-, and manifest TG-LASIK groups. However, the residual cylinder in the TMR group was significantly larger than that in the WFO and manifest TG groups. The magnitude of error in the TMR group measured using astigmatism vector analysis was significantly higher than that in the WFO and manifest TG groups.

Conclusions: Although these three LASIK platforms achieved the predicted surgical outcomes, TMR-LASIK overcorrected astigmatism and showed a higher residual postoperative astigmatism compared with WFO- and manifest TG-LASIK.

Keywords: Astigmatic overcorrection; LASIK; Topography-guided LASIK; Topography-modified refraction LASIK; Wavefront-optimized LASIK.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Refractive and visual outcomes in the wavefront-optimized group three months postoperative. (a) Cumulative distribution of uncorrected distance Snellen visual acuity (UDVA) compared with preoperative best-corrected distance visual acuity (BCVA). Forty-four (67.7%) and 60 (92.3%) eyes had a UDVA better than 20/16 and 20/20, respectively, at three months after surgery. (b) Scatter plots of attempted versus achieved manifest refraction spherical equivalent (MRSE). (c) Accuracy of MRSE. Forty-nine eyes (75.4%) had MRSE within ±0.75 D of emmetropia at three months after surgery. (d) Cumulative distribution of refractive astigmatism (RA) compared with the preoperative value. Thirty-seven (56.9%) and 48 (73.8%) eyes had an RA less than 0.25 D and 0.50 D, respectively, at three months after surgery
Fig. 2
Fig. 2
Refractive and visual outcomes in the manifest topography-guided group three months postoperative. (a) Cumulative distribution of uncorrected distance Snellen visual acuity (UDVA) compared with preoperative best-corrected distance visual acuity (BCVA). Twenty-four (60.0%) and 36 (90.0%) eyes had a UDVA better than 20/16 and 20/20, respectively, at three months after surgery. (b) Scatter plots of attempted versus achieved manifest refraction spherical equivalent (MRSE). (c) Accuracy of MRSE. Thirty-three eyes (82.5%) had MRSE within ±0.75 D of emmetropia at three months after surgery. (d) Cumulative distribution of refractive astigmatism (RA) compared with the preoperative value. Twenty-six (65.0%) and 35 (87.5%) eyes had an RA less than 0.25 D and 0.50 D, respectively, at three months after surgery
Fig. 3
Fig. 3
Refractive and visual outcomes in the topography-modified refraction group three months postoperative. (a) Cumulative distribution of uncorrected distance Snellen visual acuity (UDVA) compared with preoperative best-corrected distance visual acuity (BCVA). Fifty-two (61.2%) and 68 (80.0%) eyes had a UDVA better than 20/16 and 20/20, respectively, at three months after surgery. (b) Scatter plots of attempted versus achieved manifest refraction spherical equivalent (MRSE). (c) Accuracy of MRSE. Seventy-one eyes (83.5%) had MRSE within ±0.75 D of emmetropia at three months after surgery. (d) Cumulative distribution of refractive astigmatism (RA) compared with the preoperative value. Thirty-four (40.0%) and 61 (71.8%) eyes had an RA less than 0.25 D and 0.50 D, respectively, at three months after surgery

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