In pseudophakic patients, even low amounts of residual astigmatism can increase the odds of not achieving 20/20 or 20/16 uncorrected distance visual acuity.

Purpose: To compare the visual outcomes of LASIK procedures in which flaps were created with a femtosecond laser (IntraLase FS 60Hz, Abbott Medical Optics [AMO]) to procedures in which flaps were created with a mechanical microkeratome (Moria Evo3 One Use-Plus, Moria SA). Methods: A retrospective analysis was performed on 2000 eyes treated in 2008 for low myopia and astigmatism (sphere <−3.00 diopters [D]; cylinder ⩽−0.75 D). The first 1000 consecutive eyes that had LASIK flaps created with a femtosecond laser were compared with the first 1000 consecutive eyes that had flaps created with a mechanical microkeratome. All eyes received wavefront-guided LASIK treatments performed with a VISX S4 IR Advanced CustomVue excimer laser (AMO). Refractive predictability, change in mean spherical equivalent refraction, postoperative uncorrected visual acuity (UCVA), and loss of best spectacle-corrected visual acuity (BSCVA) were compared at 1 day, 1 week, 1 month, and 3 months following surgery. Results: The refractive accuracy was the same for both groups. At all time points measured, the percentage of eyes that achieved a postoperative UCVA of 20/20 or better was significantly higher in the femtosecond laser group than in the mechanical keratome group. Also, a higher percentage of eyes in the femtosecond laser group achieved a postoperative UCVA of 20/16 at 3 months. Finally, a lower percentage of eyes in the femtosecond laser group lost two or more lines of BSCVA at 1 week and 1 month postoperative. Conclusions: Creating LASIK flaps with the femtosecond laser resulted in faster visual recovery and better UCVA. [ J Refract Surg . 2009;25:S668–S671.]