Keith A Hettinger

Femtosecond Laser Versus Mechanical Microkeratome: A RetrospectiveComparison of Visual Outcomes at 3 Months

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 < or = -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.

Satisfaction of 13,655 patients with laser vision correction at 1 month after surgery.

PURPOSE To assess the level of laser vision correction patient satisfaction achieved by a large corporate provider of refractive surgery. METHODS A computer-based, interactive survey was used to query patients regarding their satisfaction with the services, experience, and results of their laser vision correction procedure. RESULTS Responses from 13,655 consecutive patients who completed their 1-month postoperative examination were analyzed in this study. A very high level of satisfaction was observed both for the quality of postoperative care provided (98.6%) and for the visual results obtained (95.0%). Most patients (94.2%) indicated that the surgery improved their life, and most would recommend both laser vision correction (96.5%) and the corporate provider (97.5%) to friends and family. CONCLUSIONS Patients report a high level of satisfaction with laser vision correction performed by a large corporate provider.

Early Clinical Outcomes of Wavefront-Guided Myopic LASIK Treatments Using a New-Generation Hartmann-Shack Aberrometer

PURPOSE To provide an initial retrospective evaluation of early postoperative outcomes after wavefront-guided myopic LASIK using a new-generation Hartmann-Shack wavefront sensor. METHODS A noncomparative, retrospective study of 243 eyes of 126 patients that underwent primary wavefront-guided LASIK, using wavefront data obtained with a new Hartmann-Shack aberrometer (iDesign Advanced WaveScan aberrometer; Abbott Medical Optics, Inc., Santa Ana, CA). Visual acuity, refraction, and patient satisfaction were evaluated 1 month after surgery. RESULTS The manifest spherical equivalent was reduced from -3.28 ± 1.79 diopters (D) (range: -9.88 to -0.38 D) before surgery to -0.03 ± 0.29 D (range: -1.00 to +1.25 D) 1 month after surgery. The manifest spherical equivalent was within 0.50 and 1.00 D of target in 93.0% and 99.6% of eyes, respectively. Manifest astigmatism preoperatively (-0.72 ± 0.67 [range: 0.0 to -5.00 D]) was reduced to -0.14 ± 0.20 (range: 0.0 to -1.00 D) at 1 month and the vector-derived correction ratio (surgically induced refractive change/intended refractive correction) was 1.02 ± 0.30. Uncorrected distance visual acuity of 20/16, 20/20, and 20/25 or better was achieved in 79.0%, 93.4%, and 96.7% of eyes, respectively. No eyes lost two or more lines of corrected distance visual acuity, whereas a gain of one or more lines was observed in 14.0%. Most patients (98.5%) reported that they were satisfied with the outcome of their procedure. CONCLUSIONS Wavefront-guided LASIK using the new aberrometer in this retrospective evaluation was effective, safe, and predictable in the early postoperative time period for the correction of myopia with high patient satisfaction.

The role of the mesopic pupil on patient-reported outcomes in young patients with myopia 1 month after wavefront-guided LASIK.

PURPOSE To determine the relationship between low-light pupil size and patient-reported outcomes 1 month after wavefront-guided LASIK in young patients with myopia. METHODS Retrospective case series of 10,944 eyes of 5,563 young patients with myopia who underwent wavefront-guided LASIK (6.0-mm optical zone). Preoperative pupil size was measured under low-light conditions with an infrared pupillometer. Visual and refractive outcomes were evaluated at 1 month postoperatively. A questionnaire was administered to assess patient-reported outcomes including satisfaction with the procedure, night driving, and glare and halo visual symptoms. RESULTS The average patient age was 29.8 years (range: 18 to 40 years). The mean preoperative manifest spherical equivalent of -3.49 diopters (D) (range: -0.50 to -11.75 D) was reduced to -0.04 ± 0.29 D at 1 month, with 94% of eyes achieving an uncorrected distance visual acuity of 20/20 or better. The mean low-light pupil diameter was 6.6 mm (range: 4 to 9 mm) and 1,514 patients (27.2%) had a diameter of 8 mm or larger. No correlation between pupil diameter and patient-reported outcomes was found (r range: -0.02 to 0.07). Logistic regression analysis identified postoperative uncorrected distance visual acuity and postoperative manifest refraction as significant predictors of night halo complaints after wavefront-guided LASIK (P < .01). CONCLUSIONS In this large series of young patients with myopia treated with wavefront-guided LASIK, low-light pupil diameter was not predictive of surgery satisfaction, ability to perform activities, or visual symptoms at 1 month postoperatively.

Role of depressive symptoms in patient satisfaction with visual quality after laser in situ keratomileusis.

PURPOSE: To assess the role of depressive symptoms in patient satisfaction with visual quality after laser in situ keratomileusis (LASIK). SETTING: Navy Refractive Surgery Center, Ophthalmology Department, Naval Medical Center, San Diego, California, USA. METHODS: This was a prospective study of active‐duty military patients having bilateral conventional LASIK to treat low to moderate myopia with or without astigmatism. Patients completed the Armstrong Laboratory Personality Survey Depression scale preoperatively. Patients were also given a 10‐point Navy questionnaire that included an assessment of patient satisfaction with visual quality at the 1‐ and 6‐month follow‐up examinations. Patients were stratified by their visual quality rating after LASIK as highly satisfied, satisfied, and less satisfied and by their depression scale score into low, medium, and high groups. A proportional odds model was developed to compare the visual quality rating between the 3 depression groups 1 and 6 months post LASIK. RESULTS: The study comprised 370 patients. An uncorrected visual acuity of at least 20/20 was achieved in 88.6% of eyes. Patients with higher levels of depressive symptoms had 3.0 times higher odds (95% confidence interval [CI], 1.2 to 7.4) of being less satisfied than those with low levels of depressive symptoms 1 month after LASIK (P≤.02) and 2.5 times higher odds (95% CI, 1.0 to 6.5) of being less satisfied at 6 months (P≤.06). CONCLUSION: Preoperative depressive symptoms were a significant contributor to patient satisfaction with visual quality after LASIK.

Clinical outcomes of wavefront-guided laser in situ keratomileusis to treat moderate-to-high astigmatism.

Purpose The purpose of this study was to evaluate the refractive and visual outcomes of wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopic astigmatism and cylindrical component ≥2.0 diopter (D). Methods In this retrospective study, 611 eyes that underwent LASIK for simple or compound myopic astigmatism were analyzed. Preoperative refractive cylinder ranged from −2.00 D to −6.00 D (mean −2.76±0.81 D), and the sphere was between 0.00 D and −9.75 D (mean −2.79±2.32 D). Predictability, visual outcomes, and vector analysis of changes in refractive astigmatism were evaluated. Results At 3 months after LASIK, 83.8% of eyes had uncorrected distance visual acuity of 20/20 or better, 90.3% had manifest spherical equivalent within ±0.50 D, and 79.1% had residual refractive cylinder within ±0.50 D of intended correction. The mean correction ratio for refractive cylinder was 0.92±0.14, the mean error of angle was −0.45°±2.99°, and the mean error vector was 0.37±0.38 D. A statistically significant correlation was found between the error of magnitude (arithmetic difference in the magnitudes between surgically induced refractive correction and intended refractive correction) and the intended refractive correction (r=0.26, P<0.01). Conclusion Wavefront-guided LASIK for the correction of myopic astigmatism is safe, effective, and predictable.

Flap lift and photorefractive keratectomy enhancements after primary laser in situ keratomileusis using a wavefront-guided ablation profile: Refractive and visual outcomes.

Purpose To analyze results of wavefront‐guided laser vision correction retreatments performed either by lifting the original flap or by surface ablation over the flap. Setting Optical Express, Glasgow, United Kingdom. Design Retrospective case series. Methods This retrospective study included patients grouped according to whether they had flap lift enhancement or photorefractive keratectomy (PRK) performed over the LASIK flap. All retreatment procedures were performed with the Visx Star S4 IR excimer laser with wavefront‐guided ablation profile derived from the iDesign aberrometer. Visual acuities, refractive outcomes, vector analysis of refractive cylinder and complications were analyzed in this study. The results of the last available clinical visit are presented. Results This retrospective study included 290 eyes of 202 patients divided into 2 groups: 119 eyes that had flap lift enhancement (Group A), and 171 eyes in which photorefractive keratectomy (PRK) was performed over the LASIK flap (Group B). The mean follow‐up was 4.0 ± 1.9 months in Group A and 4.2 ± 1.6 in Group B. The mean postoperative manifest spherical equivalent was −0.01 ± 0.35 D and +0.06 ± 0.39 D in Groups A and B, respectively. The percentage of eyes with postenhancement UDVA 20/20 or better was 87.4% in Group A and 79.5 % in Group B (P = .09). In Group A, 22 eyes (18.5%) developed epithelial ingrowth, of which surgical intervention was required in 2 eyes (1.7%). Grade 1 or less haze was noted in 9 (5.3%) eyes in Group B, and resolved in all cases within the first 6 postoperative months. Conclusion Both retreatment techniques were considered to be effective, predictable, and safe. Financial Disclosure Steven C Schallhorn MD is a consultant to Abbott Medical Optics and Zeiss, and Global Medical Director for Optical Express. None of the other authors have a financial or proprietary interest in the products and materials presented in this paper.

Patient-reported outcomes 5 years after laser in situ keratomileusis.

Purpose To assess vision‐related, quality‐of‐life outcomes 5 years after laser in situ keratomileusis (LASIK) and determine factors predictive of patient satisfaction. Setting Optical Express, Glasgow, Scotland. Design Retrospective case series. Methods Data from patients who had attended a clinical examination 5 years after LASIK were analyzed. All treatments were performed using the Visx Star S4 IR excimer laser. Patient‐reported satisfaction, the effect of eyesight on various activities, visual phenomena, and ocular discomfort were evaluated 5 years postoperatively. Multivariate regression analysis was performed to determine factors affecting patient satisfaction. Results The study comprised 2530 patients (4937 eyes) who had LASIK. The mean age at the time of surgery was 42.4 years ± 12.5 (SD), and the preoperative manifest spherical equivalent ranged from −11.0 diopters (D) to +4.88 D. Five years postoperatively, 79.3% of eyes were within ±0.50 D of emmetropia and 77.7% of eyes achieved monocular uncorrected distance visual acuity (UDVA) and 90.6% of eyes achieved binocular UDVA of 20/20 or better. Of the patients, 91.0% said they were satisfied with their vision and 94.9% did not wear distance correction. Less than 2.0% of patients noticed visual phenomena, even with spectacle correction. Major predictors of patient satisfaction 5 years postoperatively were postoperative binocular UDVA (37.6% variance explained by regression model), visual phenomena (relative contribution of 15.0%), preoperative and postoperative sphere and their interactions (11.6%), and eyesight‐related difficulties with various activities such as night driving, outdoor activities, and reading (10.2%). Conclusion Patient‐reported quality‐of‐life and satisfaction rates remained high 5 years after LASIK. Uncorrected vision was the strongest predictor of satisfaction. Financial Disclosure Dr. S.C. Schallhorn is a consultant to Abbott Medical Optics, Inc., Zeiss Meditec AG, and Autofocus Inc. and a global medical director for Optical Express. No other author has a financial or proprietary interest in any material or method mentioned.

Wavefront-Guided Photorefractive Keratectomy with the Use of a New Hartmann-Shack Aberrometer in Patients with Myopia and Compound Myopic Astigmatism

Purpose. To assess refractive and visual outcomes and patient satisfaction of wavefront-guided photorefractive keratectomy (PRK) in eyes with myopia and compound myopic astigmatism, with the ablation profile derived from a new Hartmann-Shack aberrometer. Methods. In this retrospective study, 662 eyes that underwent wavefront-guided PRK with a treatment profile derived from a new generation Hartmann-Shack aberrometer (iDesign aberrometer, Abbott Medical Optics, Inc., Santa Ana, CA) were analyzed. The preoperative manifest sphere ranged from −0.25 to −10.75 D, and preoperative manifest cylinder was between 0.00 and −5.25 D. Refractive and visual outcomes, vector analysis of the change in refractive cylinder, and patient satisfaction were evaluated. Results. At 3 months, 91.1% of eyes had manifest spherical equivalent within 0.50 D. The percentage of eyes achieving uncorrected distance visual acuity 20/20 or better was 89.4% monocularly and 96.5% binocularly. The mean correction ratio of refractive cylinder was 1.02 ± 0.43, and the mean error of angle was 0.00 ± 14.86° at 3 months postoperatively. Self-reported scores for optical side effects, such as starburst, glare, halo, ghosting, and double vision, were low. Conclusion. The use of a new Hartmann-Shack aberrometer for wavefront-guided photorefractive keratectomy resulted in high predictability, efficacy, and patient satisfaction.

Outcomes of wavefront-guided laser in situ keratomileusis using a new-generation Hartmann-Shack aberrometer in patients with high myopia

Purpose To evaluate refractive and visual outcomes of wavefront‐guided laser in situ keratomileusis (LASIK) to correct high myopia using a new Hartmann‐Shack aberrometer. Setting Optical Express, Glasgow, United Kingdom. Design Retrospective noncomparative case series. Methods Data of eyes that had wavefront‐guided LASIK for high myopia and myopic astigmatism (spherical equivalent [SE] between −6.00 diopters [D] and −10.25 D, up to 5.00 D of cylinder) were analyzed. The treatment profile was derived from a new‐generation Hartmann‐Shack aberrometer (iDesign Advanced Wavescan). Visual acuities, refractive outcomes, vector analysis of refractive cylinder, and patient satisfaction were assessed. Three‐months data are presented. Results Data were obtained for 621 eyes. The mean manifest SE reduced from −7.28 D ± 1.05 (SD) (range −10.25 to −6.00 D) preoperatively to −0.09 ± 0.44 D (range −2.13 to +1.38 D) at 3 months. The mean manifest cylinder changed from −1.02 ± 0.82 D (range −5.00 to 0.00 D) to −0.27 ± 0.33 D (range −1.75 to 0.00 D) postoperatively. The percentage of eyes achieving an uncorrected distance visual acuity 20/20 or better was 82.4% monocularly and 92.5% binocularly. The mean correction ratio of refractive cylinder was 1.02 ± 0.48, and the mean error of angle was −0.29 ± 14.56 degrees. A postoperative questionnaire revealed high satisfaction with the outcomes of the procedure, with low scores for night‐vision phenomena. Conclusion The results in this study were promising in terms of safety, efficacy, and predictability in eyes with high degrees of myopia. Financial Disclosure Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.