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Refractive surgery has experienced substantial advancements over the past few years, driven by innovative techniques and continuous technological progress aimed at enhancing visual outcomes and patient satisfaction. Refractive errors such as myopia, hyperopia, and astigmatism affect a significant portion of the global population, impacting quality of life and productivity. Recent advancements have been fueled by a deeper understanding of ocular biomechanics and visual optics, leading to more precise and effective treatments. Traditional methods such as LASIK and PRK have been refined, and new procedures like SMILE (Small Incision Lenticule Extraction) have been introduced, expanding the range of treatable refractive errors and improving safety and predictability. Customized treatments, such as wavefront-guided LASIK and topography-guided PRK, allow for individualized plans tailored to each patient's unique corneal characteristics, enhancing visual acuity and reducing higher-order aberrations. The use of femtosecond lasers in procedures like Femto-LASIK and femtosecond laser-assisted cataract surgery (FLACS) offers unparalleled precision, reducing surgical risks and improving outcomes. Implantable Collamer Lenses (ICLs) and corneal crosslinking (CXL) have emerged as effective options for specific patient groups. Advanced diagnostic tools like optical coherence tomography (OCT) and Scheimpflug imaging have improved surgical planning and complication management. As research and technology continue to evolve, these advancements promise even greater improvements in refractive surgery, addressing the visual needs of the global population.

This study aimed to analyze the correlations between the induction (Δ) of higher-order aberrations (HOAs) and the effective optical zone (EOZ) in keratorefractive lenticule extraction (KLEx) and wavefront-guided laser in situ keratomileusis (WG-LASIK), and to examine the effect of EOZ size on these correlations. This retrospective observational study included patients treated with KLEx and WG-LASIK for myopia or myopic astigmatism between 2018 and 2022. ΔHOAs and EOZ parameters were analyzed using Scheimpflug imaging at one month after surgery. Correlation analysis and multivariate linear regression between EOZ parameters and ΔHOAs were performed. A total of 271 eyes were included, of which 141 underwent KLEx and 130 underwent WG-LASIK. In eyes with smaller EOZ areas (≤ 24.9 mm²), EOZ decentration in KLEx showed positive correlations with Δcoma and Δvertical coma (correlation coefficient (ρ) = 0.551 and 0.524, respectively). EOZ decentration on the Y-axis in KLEx also correlated positively with Δvertical coma (ρ = 0.540), while in WG-LASIK, EOZ decentration on the X-axis correlated with Δcoma (ρ = 0.522) under similarly small EOZ areas. EOZ size parameters significantly contributed to Δspherical aberration in both procedures ( p  < 0.001). Conversely, these correlations were either not observed or significantly smaller in eyes with larger EOZ areas (> 24.9 mm²). In conclusion, maintaining a sufficiently large EOZ postoperatively is crucial. Moreover, precise surgical centration is vital for patients with smaller EOZ sizes, to reduce the induction of HOAs.

Purpose: To compare refractive, visual, and patient-reported outcomes associated with a 1st generation wavefront-guided (WFG) treatment with those associated with a 3rd generation WFG treatment. Patients and Methods: This retrospective study included patients who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) for myopia/myopic astigmatism. Two random stratified samples of patients who underwent either 1stgeneration (WaveScan, Johnson & Johnson Vision, Santa Ana, CA) or 3rd generation (iDesign 2.0, Johnson & Johnson Vision, Santa Ana, CA) treatment matched on preoperative refraction were compared (4290 eyes of 2145 patients in each group). One-month postoperative visual, refractive, and patient-reported outcomes were analyzed. Refractive and monocular visual acuity analyses were performed using one random eye of each patient. Results: The percentage of eyes achieving 20/20 or better uncorrected vision was 91.3% (1958/2145) in the 1st generation group and 95.9% (2056/2145) in the 3rd generation group (p<0.01). Binocularly, the percentage of patients with 20/20 or better UDVA was 97.0% (2080/2145) and 99.2% (2127/2145) in the 1st and 3rd generation groups, respectively (p<0.01). The mean postoperative MSE was -0.01 [+ or -] 0.33 D in the 1st generation group and +0.19 [+ or -] 0.33 D in the 3rd generation group (p<0.01). Postoperative refractive astigmatism had a mean value of -0.20 [+ or -] 0.26 D and -0.18 [+ or -] 0.24 D in the 1st and 3rd generation groups, respectively (p<0.01). The mean correction index of refractive astigmatism was 1.09 [+ or -] 0.53 in the 1st generation group and 1.02 [+ or -] 0.38 in the 3rd generation group, p<0.01. The overall percentage of patients satisfied with vision was 92.8% (1991/2145 patients) in the 1st generation group and 97.3% (2087/2145 patients) in the 3rd generation group (p<0.01). Conclusion: For the majority of postoperative variables, there were significant differences between 1st and 3rd generation treatments. The 3rd generation treatments had better visual acuity outcomes and higher patient satisfaction. Keywords: wavefront-guided LASIK, myopia, aberrometer, refractive outcomes, patient-reported outcomes

Purpose To compare the clinical outcomes of myopiacorrected with corneal-wavefront-guided (CWG) laser in situ keratomileusis (LASIK) with AMARIS 1050S (SCHWIND eye-tech-solutions GmbH & Co. KG) and corneal-topography-guided (CTG) LASIK with WaveLight EX500 (Alcon Laboratories, Fort Worth, TX). Methods In this prospective, pseudo-randomized expanded cohort study, a total of 266 patients were subjected to binocular LASIK surgery, either with WaveLight EX500 (WaveLight group) or Amaris 1050S (AMARIS group) platforms. Data related to right eyes were selected for analysis. Corneal higher-order aberration (HOA) was selected as the primary endpoint; while visual acuity and refraction were the secondary endpoints. All the endpoints were assessed at 3 months postoperatively. Results There were 134 eyes in the AMARIS group and 132 eyes in the WaveLight group. After 3 months of postoperative follow-up, spherical and coma aberrations were significantly lower ( P  < 0.05) in the WaveLight group (spherical aberration: − 0.104 ± 0.199 µm; coma aberration: − 0.117 ± 0.202 µm) in comparison with the AMARIS group (spherical aberrations: 0.254 ± 0.146 µm; coma aberrations: 0.316 ± 0.297 µm). In the AMARIS group, 96.3% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 while in the WaveLight group, 96.2% of the eyes achieved an UDVA of 20/20. Furthermore, the mean postoperative manifest refraction spherical equivalent (MRSE) was − 0.02 ± 0.28 in the AMARIS group and − 0.05 ± 0.21 in the WaveLight group ( P  = 0.34). Conclusions Both WaveLight EX500 and Amaris 1050S LASIK showed excellent refractive and visual outcomes. In addition, the WaveLight group showed minimal spherical and coma aberrations when compared to the AMARIS group.

Background To compare changes in higher-order aberrations (HOAs) following small incision lenticule extraction (SMILE) and wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG FS-LASIK), and to investigate correlations between preoperative spherical equivalence (SE) and components of HOAs affecting visual quality. Methods Sixty-five myopic eyes from 38 patients were enrolled in the study retrospectively, either having undergone SMILE or WFG FS-LASIK. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive error, and individual Zernike coefficients of 3rd- to 6th-order HOAs were measured before and 3 months after the surgeries and were compared using the Mann-Whitney test or Student’s t-test. Additional generalized estimating equation analyses (GEE) were used to control for within-subject biases in individual Zernike coefficients between the right and left eyes of the same patients. Results There was no significant difference in UDVA or CDVA after WFG FS-LASIK (Mean ± SD: −0.02 ± 0.07 and −0.04 ± 0.22 respectively, in logMAR) and after SMILE (−0.01 ± 0.06 and −0.04 ± 0.04 respectively). However, greater vertical coma aberration was found after SMILE ( p  = 0.036). Preoperative SE was correlated to induced horizontal coma ( r  = −0.608, p  = 0.001) in WFG FS-LASIK, and correlated to induced vertical coma ( r  = −0.459, p  = 0.003) in SMILE. Conclusions Both SMILE and WFG FS-LASIK can achieve planned visual outcomes in correcting myopia and myopic astigmatism. However, higher vertical coma was shown in SMILE than WFG FS-LASIK which might be a potentially impact factor for patients’ vision under certain lighting conditions and needs further investigation.

The purpose of this study was to evaluate the visual, refractive, and aberrometric outcomes as well as the level of patient satisfaction and photic phenomena after myopic laser in situ keratomileusis (LASIK) surgery using wavefront-guided (WFG) ablations based on measurements obtained with a high-resolution aberrometer. This study was a prospective analysis including 253 eyes of 127 patients (aged between 19 years and 54 years) undergoing WFG LASIK using the STAR S4 IR Excimer Laser System combined with the iDesign System and iFS Femtosecond Laser. Visual, refractive, and aberrometric outcomes during a 2-month follow-up as well as patient satisfaction and photic phenomena were evaluated by means of a questionnaire. A total of 85% (215/253) and 99% (251/253) of eyes achieved a postoperative (Postop) uncorrected distance visual acuity of 20/16 and 20/20, respectively, and all eyes achieved an uncorrected distance visual acuity of 20/25. Postop spherical equivalent values were within ±0.25 D and ±0.50 D in 97% and 100% of eyes, respectively. Likewise, manifest cylinder was <0.25 D in 97% (245/253) of eyes. A statistically significant reduction was found in the total root mean square ( <0.001) and in the level of primary spherical aberration ( =0.001). Postop difficulties related to vision were graded as minimal, with low levels of photic phenomena and high levels of patient satisfaction. The level of difficulty to perform daily activities and the level of glare perceived by patients while driving car were significantly decreased ( <0.001). WFG LASIK surgery using the technology evaluated is predictable and effective for the correction of myopia and leads to high levels of patient satisfaction.

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). 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. 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). Wavefront-guided LASIK for the correction of myopic astigmatism is safe, effective, and predictable.

To compare and analyze the differences in visual outcomes between Visx iDesign Advanced WaveScan Studio™ System, Alcon Wavelight Allegro Topolyzer and Nidek EC-5000 using Final Fit™ Custom Ablation Treatment Software from the submitted summary of safety and effectiveness of the US Food and Drug Administration (FDA) data. In this retrospective comparative study, 334 eyes from Visx iDesign, 212 eyes from Alcon Contour, and 135 eyes from Nidek CATz platforms were analyzed for primary and secondary visual outcomes. These outcomes were compared via side-by-side graphical and tabular representation of the FDA data. Statistical significance was calculated when appropriate to assess differences. A -value <0.05 was considered statistically significant. The mean postoperative uncorrected distance visual acuity (UDVA) at 12 months was 20/19.25±8.76, 20/16.59±5.94, and 20/19.17±4.46 for Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. In at least 90% of treated eyes at 3 months and 12 months, all three lasers showed either no change or a gain of corrected distance visual acuity (CDVA). Mesopic contrast sensitivity at 6 months showed a clinically significant increase of 41.3%, 25.1%, and 10.6% for eyes using Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. Photopic contrast sensitivity at 6 months showed a clinically significant increase of 19.2%, 31.9%, and 10.6% for eyes using Visx iDesign, Alcon Contoura, and Nidek CATz, respectively. FDA data for the three platforms shows all three were excellent with respect to efficacy, safety, accuracy, and stability. However, there are some differences between the platforms with certain outcome measurements. Overall, patients using all three lasers showed significant improvements in primary and secondary visual outcomes after LASIK surgery.

To evaluate the impact of ocular residual astigmatism (ORA) on the astigmatic correction outcomes of wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG FS-LASIK) in myopic astigmatism patients. Retrospective cohort study. This study analyzed 90 patients (177 eyes) undergoing WFG FS-LASIK at Chongqing Medal Eye Institute between January 2015 and May 2021, all with complete follow-up data spanning 15 days–6 months postoperatively. Participants were categorized into three groups based on the ratio of ORA to refractive astigmatism (RA), and the axial difference between ORA and anterior corneal astigmatism (ACA): Group1 (42 eyes): |ORA|/|RA| < 1 and the axial difference between ORA and ACA was ≦ 45°. Group 2 (86 eyes): |ORA|/|RA| < 1 and the axial difference between ORA and ACA was > 45°. Group3 (49 eyes): |ORA|/|RA| > 1 and the axial difference between ORA and ACA was > 45°. Uncorrected distance visual acuity (UDVA) at 6 months postoperatively was compared among the three groups. Alpins vector analysis was performed to compare the accuracy of astigmatic correction, quantified by: Angle of error (AE): axial deviation between the surgically induced astigmatism (SIA) and target induced astigmatism (TIA); Correction index (CI): ratio of SIA to TIA (ideal value = 1.0). The mean |AE| values significantly differed among groups ( P  < 0.05), being lowest in Group 1 (9.29°) and highest in Group 3 (26.64°). Correction index (CI) defined as the ratio of SIA to TIA. The mean CI values were1.00 (Group 1), 1.19 (Group 2) and 3.26 (Group 3).No statistically significant differences were observed in postoperative UDVA among the three groups ( P  > 0.05). In WGF FS-LASIK, the consistency between the axis of ORA and ACA affects the degree of deviation in astigmatic axis correction, but had no significant impact on UDVA.