Prk Vs Lasik For Against-The-Rule Astigmatism: A Retrospective Cohort Study
Published 2026 - 44th Congress of the ESCRS
Reference: PP10.12 | Type: Free paper | DOI: 10.82333/eq5b-q510
Authors: Dr Adir Sommer* 1 , Dr Dror Ben Ephraim Noyman 1 , Dr Margarita Safir 2 , Dr Waseem Nasser 1 , Mr Tzahi Sela 3 , Mr Gur Munzer 3 , A/Prof. Igor Kaiserman 4 , A/Prof. Michael Mimouni 1
1Rambam Health Care Campus,Haifa,Israel, 2Rabin Medical Center,Petah Tikva,Israel, 3Care-Vision Laser Center,Tel-Aviv,Israel, 4Barzilai Medical Center,Ashkelon,Israel
Purpose
To compare visual and refractive outcomes, astigmatic vector correction quality, and complications after Photorefractive Keratectomy (PRK) versus Laser-Assisted In Situ Keratomileusis (LASIK) in against-the-rule (ATR) eyes, and to identify predictors of suboptimal outcomes.
Setting
A retrospective comparative study conducted at Care Vision Laser Center, Tel Aviv, Israel.
Methods
The study included consecutive myopic patients over 18 years of age with against-the-rule astigmatism, aimed for emmetropia with no ocular comorbidities or prior surgeries who underwent PRK or LASIK between 2013 and 2024. Baseline characteristics were compared and matched upon using propensity score matching. Refractive and visual outcomes were assessed, and an Alpins vector analysis was performed.
Results
After matching for baseline characteristics, a total of 1136 eyes from 924 patients were analyzed (age: 33.9±10 years, 42.7% female). Matching was successful with background and intraoperative parameters showing no significant differences. In the timeframe assessed, LASIK showed significant superiority compared to PRK in BCVA (0.99 vs 0.97, p<0.001), Safety Index (1.03 vs 1.00, p<0.001), Magnitude of Error (0.13 vs 0.18, p=0.02), and Correction Index (1.21 vs 1.28, p=0.03).
Conclusions
This propensity-matched study demonstrates that LASIK outperforms PRK for correcting myopic ATR astigmatism. LASIK achieved statistically superior safety, visual acuity, and vector correction accuracy compared to surface ablation. Consequently, these findings support LASIK as the preferred modality for eligible ATR candidates, providing critical evidence for axis-specific surgical selection.