Comparison of clinical and patient-reported outcomes of contralateral topography-guided vs wavefront-guided LASIK.

Abstract

Purpose: To compare 6-month visual and patient-reported outcomes between topography-guided (TG) using Contoura with Phorcides and wavefront-guided (WFG) LASIK using iDesign 2.0 laser-assisted in situ keratomileusis (LASIK).

Setting: Joint Warfighter Refractive Surgery Center, Lackland Air Force Base, Texas.

Design: Prospective, double-blind, randomized.

Methods: 66 participants receive TG-LASIK in one eye and WFG-LASIK in the contralateral eye. Preoperative and postoperative assessments included uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, higher-order aberrations (HOAs), Schirmer test, and validated questionnaires (Patient-Reported Outcomes with LASIK-Symptoms and Satisfaction; Standard Patient Evaluation of Eye Dryness). Flaps were created with the Zeiss VisuMax femtosecond laser, followed by TG or WFG excimer laser ablation. Outcomes were evaluated at multiple timepoints through 6 months.

Results: At 6 months, 54% of WFG-LASIK eyes and 46% of TG-LASIK eyes achieved UDVA of 20/16 or better ( P = .48). TG-LASIK showed a higher efficiency index (1.08 vs 1.02; P = .03) and better mean spherical equivalent (0.04 diopters [D] vs 0.13 D; P = .04), while WFG-LASIK had superior low-contrast UDVA and CDVA. Safety indices, residual HOAs, and dry eye symptoms were similar between groups. Both procedures significantly improved patient satisfaction and reduced visual disturbances compared with baseline.

Conclusions: Both TG-LASIK and WFG-LASIK using the latest excimer and diagnostic platforms, Contoura with Phorcides on the WaveLight EX500 and iDesign 2.0 on the VISX STAR S4 IR, are highly effective and safe options for customized refractive correction.