A prospective, randomized, fellow eye comparison of WaveLight® Allegretto Wave® Eye-Q versus VISX CustomVue™ STAR S4 IR™ in laser in situ keratomileusis (LASIK): analysis of visual outcomes and higher order aberrations

Abstract

PurposeTo compare outcomes in visual acuity, refractive error, higher-order aberrations (HOAs), contrast sensitivity, and dry eye in patients undergoing laser in situ keratomileusis (LASIK) using wavefront (WF) guided VISX CustomVue and WF optimized WaveLight Allegretto platforms.MethodsIn this randomized, prospective, single-masked, fellow eye study, LASIK was performed on 44 eyes (22 patients), with one eye randomized to WaveLight Allegretto, and the fellow eye receiving VISX CustomVue. Postoperative outcome measures at 3 months included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, root-mean-square (RMS) value of total and grouped HOAs, contrast sensitivity, and Schirmers testing.ResultsMean values for UDVA (logMAR) were −0.067 ± 0.087 and −0.073 ± 0.092 in the WF optimized and WF guided groups, respectively (P = 0.909). UDVA of 20/20 or better was achieved in 91% of eyes undergoing LASIK with both lasers while UDVA of 20/15 or better was achieved in 64% of eyes using the Allegretto platform, and 59% of eyes using VISX CustomVue (P = 1.000). In the WF optimized group, total HOA increased 4% (P = 0.012), coma increased 11% (P = 0.065), and spherical aberration increased 19% (P = 0.214), while trefoil decreased 5% (P = 0.490). In the WF guided group, total HOA RMS decreased 9% (P = 0.126), coma decreased 18% (P = 0.144), spherical aberration decreased 27% (P = 0.713) and trefoil decreased 19% (P = 0.660). One patient lost one line of CDVA secondary to residual irregular astigmatism.ConclusionBoth the WaveLight Allegretto and the VISX CustomVue platforms had equal visual and safety outcomes. Most wavefront optimized HOA values trended upward, with a statistically significant increase in total HOA RMS. Eyes treated with the WF guided platform showed a decreasing trend in HOA values.

Retrospective Analysis of the Post-Operative Changes in Higher-Order Aberrations: A Comparison of the WaveLight EX500 to the VISX S4 Laser in Refractive Surgery

“…The study is likely limited by its power, given the small population size (n). All subjects having had 7 Additional limitations of the study include its design, being a retrospective analysis, and the generalizability of the study, as the DoD population may be significantly different from the typical refractive surgery population in terms of overall health and preoperative refractive error. Furthermore, as the RMS value of higher-order aberrations was examined and each higher-order aberration was not separately analyzed, the true effect of the laser in terms of the specific higher-order aberrations is not known.…”

“…6 Furthermore, the platforms had equal visual acuity outcomes when used for LASIK even though a statistically significant increase in total higher-order aberrations was noted with the WaveLight Allegretto and eyes treated with the VISX CustomVue showed a decreasing trend in higher-order aberrations. 7 Some have argued that the change in higher-order aberrations may be more clinically noted than the absolute change. Unfortunately, it is difficult to quantify subjective reports of visual disturbances, which may or may not directly affect visual acuity.…”

“…5 Moshirfar et al demonstrated both the VISX CustomVue and WaveLight Allegretto systems perform equally in terms of visual acuity, safety, and predictability in both PRK and LASIK refractive surgery procedures. 6,7 Both platforms induced a comparable degree of higher-order and spherical aberrations during PRK, though no statistically significant difference in terms of the RMS of higher-order optical aberrations was demonstrated. 6 Interestingly, eyes treated with the wavefront-guided VISX CustomVue were shown to have decreased higher-order aberrations following LASIK, whereas eyes treated with the wavefront-optimized Allegretto had an upward trend in higher-order aberration values.…”

“…6 Interestingly, eyes treated with the wavefront-guided VISX CustomVue were shown to have decreased higher-order aberrations following LASIK, whereas eyes treated with the wavefront-optimized Allegretto had an upward trend in higher-order aberration values. 7 Molchan et al demonstrated a smaller change in corneal asphericity per diopter of treatment with myopic correction using the Allegretto wavefront-optimized laser when compared to the VISX wavefront-guided laser for refractive surgery. 8 Lee and Lee demonstrated the WaveLight Refractive Suite, consisting of the femtosecond laser FS200 and WaveLight EX500 excimer laser, offers good refractive predictability in LASIK procedures.…”

Meta-analysis of Six Excimer Laser Platforms for Safety and Efficacy in Myopic Laser-assisted in situ Keratomileusis

“…Abbott excimer platform-20/10-22 %, 6 20/12.5-81 %, 6 20/16-95 %, 6 20/20-99 % 6 Alcon excimer platform-20/12.5-21 %, 35 20/16-64 %, 12 20/20-92 % 18 Carl Zeiss excimer platform-20/16-65 %, 16 Table 1). …”