Several excimer lasers and ablation (laser treatment) programs are available for refractive surgeons to use to perform LASIK surgery.
Recently, Perry S. Binder, MD, a prominent refractive surgeon in San Diego, California, retrospectively reviewed the outcomes of LASIK procedures he performed using several different excimer lasers and ablation algorithms (computerized treatment programs). His goal was to see which of these combinations produced the best LASIK outcomes for his patients.
LASIK comparison: Study design and methods
Dr. Binder compared the results of 721 eyes of 458 myopic patients who underwent LASIK surgery in his practice. He performed all the LASIK surgeries in the study group himself.
Five different treatment groups were analyzed:
- Conventional LASIK with a Visx Star excimer laser (Abbott Medical Optics, Santa Ana, Calif.)
- CustomVue wavefront-guided LASIK with a Visx Star excimer laser
- Conventional LASIK with a LADARVision excimer laser (Alcon, Inc., Fort Worth, Texas)
- Wavefront-guided LASIK with a LADARVision excimer laser
- Wavefront-optimized LASIK with an Allegretto Wave excimer laser (Alcon, Inc.)
In all cases, the corneal flap was created with an IntraLase femtosecond laser, and aberrometry measurements were taken before and after surgery to determine the level of pre-op and post-op higher-order aberrations.
Follow-up exams were performed for a minimum of one month after all surgeries and the mean follow-up for the five treatment groups ranged from one to 26 months.
Results were evaluated separately for patients who had no pre-operative astigmatism (“spheres” group) and those who did (“spherocylinders” group).
Results and conclusions
Analysis of the data in the study revealed:
- All laser platforms used for LASIK performed well and improved uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA).
- CustomVue wavefront-guided LASIK produced the best UCVA results among spheres, with 42 percent seeing 20/16 or better after surgery.
- Wavefront-optimized LASIK with the Allegretto Wave laser produced the best UCVA results among spherocylinders, with 30 percent attaining 20/16 or better uncorrected visual acuity after surgery.
- Overall, CustomVue wavefront-guided ablations with the VISX laser provided better visual outcomes than conventional LASIK ablations with the same laser.
- Wavefront-guided ablations with the LADARVision laser provided similar outcomes as conventional LASIK treatments with the same laser.
- All of the lasers induced higher-order aberrations (HOAs).
- Patients with greater pre-operative HOAs did better with a wavefront-guided or wavefront-optimized LASIK treatment than with a conventional LASIK treatment.
- The CustomVue wavefront-guided LASIK treatment was best overall in keeping HOAs to a minimum.
Based on the results of this study, Dr. Binder says he significantly increased the percentage of CustomVue wavefront-guided LASIK procedures he performs, as this procedure appears to provide the best overall outcomes.
SOURCE: Comparing conventional, custom and wavefront-optimized LASIK. EyeWorld. May 2009. (Supplement: Premium Clinical Options for Cataract and Refractive Surgery, sponsored by Abbott Medical Optics.)
Tags: excimer, laser treatment