Incidence of rainbow glare after laser in situ keratomileusis flap creation with a 60 kHz femtosecond laser.

Purpose: To report the incidence of and factors associated with rainbow glare after laser in situ keratomileusis (LASIK) flap creation with a 60 kHz femtosecond laser.

Setting: Department of Refractive Surgery, Cleveland Clinic Cole Eye Institute, Cleveland, Ohio, USA.

Methods: Consecutive patients having LASIK by the same surgeon were questioned during postoperative examinations or by telephone about postoperative rainbow glare (radiating colors around a white light at night). Femtosecond laser (IntraLase) settings included pulse frequency 60 kHz, flap thickness 90 to 110 mum, and spot/line separation 8 mum. Raster energy was 0.8 microJ (75% of eyes) and 1.0 to 1.1 microJ (25%). Excimer laser ablation was performed with the LADAR 4000 or 6000 platform using custom or conventional treatments.

Results: Of 260 consecutive patients, 256 (98.5%) were successfully contacted. Fifteen patients (28 eyes) reported postoperative rainbow glare (5.8%), described as 4 to 12 bands of color around a white light, with 6 bands most common. The symptom did not correlate with refractive error, age, or sex but was more frequent at 1.0 microJ or 1.1 microJ raster energy (11.6%) than at 0.8 microJ (4.1%). The incidence followed a bimodal distribution, with the first grouping due to inadequate alignment and higher energy just after laser installation and the second just before a later maintenance service call.

Conclusion: Rainbow glare is a mild optical side effect of femtosecond LASIK. In this study, higher raster energy levels and length of time between service calls were associated with the occurrence of rainbow glare.