Prospective Intraindividual Comparison Of Functional Outcomes After Automated Customized Ray-Tracing-Guided Vs. Wavefront-Optimized Laser In Situ Keratomileusis

To compare automated customized ray-tracing-guided laser in situ keratomileusis (LASIK) with wavefront-optimized LASIK by assessing intraindividual refractive and visual acuity outcomes.

International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany

Prospective, interventional, randomized, double-blinded, contralateral-eye comparison. In 30 patients (60 eyes) with myopia and myopic astigmatism, ray-tracing-guided LASIK (wavelight plus, Alcon) was performed in one eye with the ablation profile calculated automatically by ray-tracing, using only objective measurements; while in the fellow eye, the manifest refraction was used for planning wavefront-optimized LASIK treatment. Preoperative and postoperative (up to 3 months) examinations included manifest refraction, uncorrected (UDVA) and corrected (CDVA) distance visual acuity.

At 3 months after wavelight plus and wavefront-optimized LASIK, MRSE was within ±0.50D in 100% and 90.0% of eyes (wavelight plus not inferior, p=0.125), and within ±0.25D in 83.3% and 76.7% of eyes (wavelight plus not superior, p=0.313), respectively. The mean (±SD) MRSE was -0.05±0.21D after wavelight plus and -0.16±0.23D after wavefront-optimized LASIK (p=0.039). Monocular UDVA was -0.11±0.07 logMAR and -0.09±0.09 logMAR, CDVA was -0.14± 0.05 logMAR and -0.13±0.06 logMAR, efficacy index was 1.01±0.14 and 0.98±0.16, safety index was 1.08±0.13 and 1.07±0.14 for wavelight plus and wavefront-optimized LASIK, respectively (p>0.05).

The ray-tracing-guided LASIK had a high safety and efficacy, with comparable visual acuity outcomes to those after wavefront-optimized LASIK. Without the need of manifest refraction, wavelight plus achieved non-inferior refractive outcomes with a slightly higher accuracy in MRSE.