Wavefront-Guided versus Non-Wavefront-Guided Photorefractive Keratectomy for Myopia: Meta-Analysis of Randomized Controlled Trials

Abstract

PurposeTo compare the efficacy, predictability, safety, and induced higher-order aberrations (HOAs) between wavefront-guided and non-wavefront-guided photorefractive keratectomy (PRK).MethodsThe Cochrane Central Register of Controlled Trials, PubMED, and EMBASE were searched for randomized controlled trials. Trials meeting the selection criteria were quality appraised, and data was extracted by 2 independent authors. Measures of association were pooled quantitatively using meta-analytical methods. Comparisons between wavefront-guided and non-wavefront-guided ablations were made as pooled odds ratios (ORs) or weighted mean differences. The pooled ORs and 95% confidence intervals (CIs) were computed for efficacy, safety, and predictability. The weighted mean differences and 95% CIs were used to compare induced HOAs.ResultsThe study covered five trials involving 298 eyes. After wavefront-guided PRK, the pooled OR of achieving an uncorrected distance visual acuity of 20/20 (efficacy) was 1.18 (95% CI, 0.53–2.60; p = 0.69), the pooled OR of achieving a result within ±0.50 diopter of the intended target (predictability) was 0.86 (95% CI, 0.40–1.84; p = 0.70). No study reported a loss of 2 or more lines of Snellen acuity (safety) with either modality. In eyes with wavefront-guided PRK, the postoperative trefoil aberrations (mean difference −0.02; 95% CI, −0.03 to −0.00; p = 0.03) were significantly lower. There were no significant differences between the two groups in the postoperative total HOAs (mean difference −0.04; 95% CI, −0.23 to 0.14; p = 0.63), spherical (mean difference 0.00; 95% CI, −0.08 to 0.09; p = 0.93), and coma (mean difference −0.06; 95% CI, −0.14 to 0.03; p = 0.20) aberrations.ConclusionsAccording to the meta-analysis, wavefront-guided PRK offered no advantage in efficacy, predictability, or safety measures over non-wavefront-guided PRK, although it may have induced fewer trefoil aberrations.

Characteristics of corneal high-order aberrations in adolescents with mild to moderate myopia

“…There is some controversy regarding the relationship between human eye HOAs and myopia diopter. Some studies [ 23 , 24 ] showed more positive HOAs in higher diopter myopia, whereas other studies [ 25 , 26 ] showed less positive HOAs in higher diopter myopia. Moreover, other research studies [ 8 , 25 ] showed no relationship between HOAs and myopia diopter.…”

“…Some studies [ 23 , 24 ] showed more positive HOAs in higher diopter myopia, whereas other studies [ 25 , 26 ] showed less positive HOAs in higher diopter myopia. Moreover, other research studies [ 8 , 25 ] showed no relationship between HOAs and myopia diopter. Our study focused on cornea HOAs and mild to moderate myopic eyes in adolescents.…”

Four-year follow-up of corneal aberrations and visual functionsof myopic patients after laser in situ keratomileusis

“… 3 , 4 To decrease the aberrations and improve the visual quality, today several customized cutting pattern are performed. 5 - 7 Unfortunately still there is no perfect effect about the corneal refractive surgery. In this present study we observed the corneal aberrations and visual functions of myopic patients after LASIK guided by aspherical ablation with 4-year follow-up to explore their long-term stability.…”