Prospective Evaluation of Outcomes in Patients Undergoing Treatment for Myopia Using the WaveLight Refractive Suite
Abstract
PURPOSE:
To evaluate outcomes in patients with myopia up to −12.00 diopters (D), with or without astigmatism up to 6.00 D, who underwent LASIK with the WaveLight Refractive Suite (Alcon Laboratories, Inc., Fort Worth, TX).
METHODS:
This multicenter, prospective, single-arm study evaluated patients at baseline, on the day of surgery, and 1 day and 1, 3, and 6 months postoperatively. The primary outcome was comparison of 1-month postoperative binocular uncorrected distance visual acuity (UDVA) with preoperative binocular corrected distance visual acuity (CDVA). Noninferiority was defined as the upper bound of the 95% confidence interval less than 0.1 logMAR. Post-hoc analyses for superiority were conducted for monocular and binocular CDVA at 1, 3, and 6 months. Continuous variables were summarized using mean (95% confidence interval), median, quartiles, standard deviation, minimum and maximum, and categorical variables as counts and percentages.
RESULTS:
Of the 96 patients (54% female, mean age: 31 years), 5 underwent monocular and 91 binocular LASIK surgery (187 eyes). Preoperatively, mean binocular CDVA was −0.025 ± 0.126 logMAR, mean binocular UDVA was 1.148 ± 0.626 logMAR, and mean manifest spherical refraction equivalent was −3.67 ± 1.98 D. Postoperative binocular UDVA at 1 month (−0.088 ± 0.107 logMAR) was noninferior to preoperative binocular CDVA. Postoperative binocular UDVA at 1, 3 (−0.098 ± 0.107 logMAR), and 6 months (−0.105 ± 0.113 logMAR) were significantly superior to preoperative binocular CDVA (P < .0001 each).
CONCLUSIONS:
The primary study objective was exceeded; postoperative UDVA was significantly superior to preoperative CDVA in patients with myopia and myopia with astigmatism who underwent LASIK with the WaveLight Refractive Suite.
[J Refract Surg. 2017;33(5):322–328.]
- 1.U. S. Food and Drug Administration. List of FDA-Approved Lasers for LASIK. Posted August 17, 2015. Available at: http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/SurgeryandLifeSupport/LASIK/ucm192109.htm. Accessed January 27, 2016. Google Scholar
- 2.Krueger RR, Rabinowitz YS, Binder PS. The 25th anniversary of excimer lasers in refractive surgery: historical review. J Refract Surg. 2010; 26:749–760.
10.3928/1081597X-20100921-01 Link, Google Scholar - 3.Corcoran KJ. Macroeconomic landscape of refractive surgery in the United States. Curr Opin Ophthalmol. 2015; 26:249–254.
10.1097/ICU.0000000000000159 Crossref Medline, Google Scholar - 4.Farjo AA, Sugar A, Schallhorn SC, Femtosecond lasers for LASIK flap creation: a report by the American Academy of Ophthalmology. Ophthalmology. 2013; 120:e5–e20.
10.1016/j.ophtha.2012.08.013 Crossref Medline, Google Scholar - 5.Santhiago MR, Kara-Junior N, Waring GO. Microkeratome versus femtosecond flaps: accuracy and complications. Curr Opin Ophthalmol. 2014; 25:270–274.
10.1097/ICU.0000000000000070 Crossref Medline, Google Scholar - 6.Lee MW, Lee YC. Initial experience with the WaveLight Refractive Suite for myopic laser in situ keratomileusis. Asia Pac J Ophthalmol (Phil). 2012; 1:222–225.
10.1097/APO.0b013e318260f730 Crossref Medline, Google Scholar - 7.Kanellopoulos AF, Asimellis G. Long-term bladeless LASIK outcomes with the F200 Femtosecond and EX500 Excimer laser workstation: the Refractive Suite. Clin Ophthalmol. 2013; 7:261–269.
10.2147/OPTH.S40454 Crossref Medline, Google Scholar - 8.Kanellopoulos A, Asimellis G. Refractive and keratometric stability in high myopic LASIK with high-frequency femtosecond and excimer lasers. J Refract Surg. 2013; 29:832–837.
10.3928/1081597X-20130924-02 Link, Google Scholar - 9.Mrochen M, Donitzky C, Wüllner C, Loffler J. Wavefront-optimized ablation profiles: theoretical background. J Cataract Refract Surg. 2004; 30:775–785.
10.1016/j.jcrs.2004.01.026 Crossref Medline, Google Scholar - 10.Stulting RD, Carr JD, Thompson KP, Waring GO, Wiley WM, Walker JG. Complications of laser in situ keratomileusis for the correction of myopia. Ophthalmology. 1999; 106:13–20.
10.1016/S0161-6420(99)90000-3 Crossref Medline, Google Scholar - 11.American National Standards Institute. American National Standard for Ophthalmics: Laser Systems for Corneal Reshaping. Document ANSI Z-80.11–2012. Posted August 9, 2012. Available at: http://webstore.ansi.org/RecordDetail.aspx?sku=ANSI+Z80.11-2012. Accessed January 27, 2016. Google Scholar
- 12.Khoramnia R, Salgado JP, Lohmann CP, Kobuch KA, von Mohrenfels CW. Precision, morphology, and histology of corneal flap cuts using a 200-kHz femtosecond laser. Eur J Ophthalmol. 2012; 22:161–167.
10.5301/EJO.2011.8376 Crossref Medline, Google Scholar - 13.Shetty R, Malhotra , D'Souza S, Wadia K. WaveLight FS200 vs Hansatome LASIK: intraoperative determination of flap characteristics and predictability by hand-held bioptigen spectral domain imaging system. J Refract Surg. 2012; 28(suppl 11):S815–S820.
10.3928/1081597X-20121005-01 Link, Google Scholar - 14.Zhang Y, Chen YG, Xia YJ. Comparison of corneal flap morphology using AS-OCT in LASIK with the WaveLight FS200 femtosecond laser versus a mechanical microkeratome. J Refract Surg. 2013; 29:320–324.
10.3928/1081597X-20130415-03 Link, Google Scholar - 15.Sugar A, Rapuano CJ, Culbertson WW, Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: a report by the American Academy of Ophthalmology. Ophthalmology. 2002; 109:175–187.
10.1016/S0161-6420(01)00966-6 Crossref Medline, Google Scholar - 16.Rosman M, Hall RC, Chan C, Comparison of efficacy and safety of laser in situ keratomileusis using 2 femtosecond laser platforms in contralateral eyes. J Cataract Refract Surg. 2013; 39:1066–1073.
10.1016/j.jcrs.2013.02.038 Crossref Medline, Google Scholar - 17.Hashemi H, Miraftab M, Ghaffari R, Asgari S. Femtosecond-assisted LASIK versus PRK: comparison of 6-month visual acuity and quality outcome for high myopia [published online ahead of print December 9, 2015]. Eye Contact Lens. Google Scholar
- 18.Padmanabhan P, Mrochen M, Basuthkar S, Viswanathan D, Joseph R. Wavefront-guided versus wavefront-optimized laser in situ keratomileusis: contralateral comparative study. J Cataract Refract Surg. 2008; 34:389–397.
10.1016/j.jcrs.2007.10.028 Crossref Medline, Google Scholar

