Retrospective Study Comparing Topography Guided and Wavefront Optimized Lasik Procedures in a Single Center

My name is Dr. Sheri Rowen. I am an ophthalmic surgeon in private practice in Orange County, California, where I specialize in advanced cataract and refractive surgery, as well as treatment of dry eye and ocular surface disease. LASIK is a commonly performed procedure that can improve patients’ vision and in turn, reduce or eliminate their dependence on glasses or contact lenses.1 It is also a field that is continuously evolving, and understanding the relative advantages of different LASIK techniques can help surgeons optimize our patients’ outcomes. I recently conducted an investigator-initiated trial to evaluate and compare refractive and visual acuity outcomes in patients undergoing topography guided or wavefront optimized LASIK for myopia or myopic astigmatism. The study had a retrospective design and examined post-operative outcomes in 227 eyes that underwent topography guided LASIK and 121 eyes that underwent wavefront optimized LASIK treatments at a single surgical center. All surgeries were performed using the WaveLight® EX500 excimer laser. One and three months post-operatively, refractive results and uncorrected and best corrected distance visual acuity were assessed in both treatment groups. Looking at the post-operative data, eyes that underwent topography guided LASIK had good mean refractive outcomes, including sphere, cylinder, and mean spherical equivalent refractive error, and corresponding values in eyes that underwent wavefront optimized LASIK were comparable. The percentage of patients achieving 20/20 uncorrected distance visual acuity was similar in both groups. One month post-surgery, 96% of patients who underwent topography guided LASIK had 20/20 or better acuity, and 94% of patients in the wavefront optimized LASIK group met this criterion. At three months, 98% and 95% of patients had 20/20 acuity or better after topography guided and wavefront optimized LASIK, respectively. A closer look at the data revealed that 35% of patients who underwent topography guided LASIK achieved 20/16 uncorrected distance visual acuity at one month, and this number increased to 62% at three months. In comparison, less than 20% of patients in the wavefront optimized LASIK group were 20/16 or better at either time point. Finally, 51% of patients treated with topography guided LASIK had gained at least one line of best corrected visual acuity at three months, in comparison to pre-operative performance. Among the smaller number of patients in the wavefront optimized LASIK group, 18% had a gain of at least one line. From a technical perspective, topography-guided LASIK offers the advantage of integrating a topographic profile of the cornea into its calculations. This helps the surgeon create a uniform corneal surface and reduce aberrations. The current study found that both topography guided and wavefront optimized treatments provided excellent refractive results. Even more notably, topography guided LASIK using the WaveLight® EX500 excimer laser resulted in large percentages of patients achieving a high degree of uncorrected visual acuity or a gain in acuity of at least one line. Taken together, these findings indicate that, for patients who qualify for topography guided LASIK, this approach may help to improve overall post-operative best vision. © 2022 Alcon Inc. US-WLC-2200016