Comparative analysis of the efficacy of astigmatic correction after wavefront-guided and wavefront-optimized LASIK in low and moderate myopic eyes.

Aim: To evaluate and compare the efficacy of the astigmatic correction achieved with laser keratomileusis (LASIK) in eyes with myopic astigmatism using wavefront-guided (WFG) and wavefront-optimized (WFO) ablation profiles.

Methods: Prospective study included 221 eyes undergoing LASIK: 99 and 122 eyes with low and moderate myopic astigmatism (low and moderate myopia groups). Two subgroups were differentiated in each group according to the ablation profile: WFG subgroup, 109 eyes (45/64, low/moderate myopia groups) treated using the Advanced CustomVue platform (Abbott Medical Optics Inc.), and WFO subgroup, 112 eyes (54/58, low/moderate myopia groups) treated using the EX-500 platform (Alcon). Clinical outcomes were evaluated during a 6-month follow-up, including a vector analysis of astigmatic changes.

Results: Significantly better postoperative uncorrected visual acuity and efficacy index was found in the WFG subgroups of each group (≤0.041). Postoperative spherical equivalent and cylinder were significantly higher in WFO subgroups (≤0.003). In moderate myopia group, a higher percentage of eyes with a postoperative cylinder ≤0.25 D was found in the WFG subgroup (90.6% 65.5%, =0.002). In low and moderate myopia groups, the difference vector was significantly higher in the WFO subgroup compared to WFG (<0.001). In moderate myopia group, the magnitude (=0.008) and angle of error (<0.001) were also significantly higher in the WFO subgroup. Significantly less induction of high order aberrations were found with WFG treatments in both low and moderate myopia groups (≤0.006).

Conclusion: A more efficacious correction of myopic astigmatism providing a better visual outcome is achieved with WFG LASIK compared to WFO LASIK.