Presented at: American Academy of Ophthalmology Annual Meeting, November 2006, Las Vegas, Nevada.
Received 21 August 2006; accepted 15 October 2006. published online 05 March 2007.
Purpose
To compare early visual outcomes after wavefront-optimized advanced surface ablation (ASA) with those after wavefront-optimized LASIK.
Design
Retrospective comparative series.
Participants
One hundred thirty-six eyes undergoing ASA and 136 preoperative refraction–matched eyes undergoing LASIK from June 2004 through October 2005.
Methods
Database review of preoperative characteristics, including patient age, gender, refraction, and central corneal pachymetry; perioperative information, including type of surgery, flap thickness (for LASIK cases), ablation depth, and residual stromal bed thickness; and postoperative information, including uncorrected visual acuity (UCVA) at 1 day, 1 week, 2 weeks, and 3 months, refraction at 3 months, and complications. All ASA patients had topical mitomycin C applied intraoperatively.
Main Outcomes Measures
Postoperative UCVA, best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) refraction, speed of visual recovery, and postoperative complications.
Results
Surface ablation patients were younger (35.4 years vs. 39.8 years, P = 0.0002) and had thinner corneas (514 μm vs. 549 μm, P<0.0001) preoperatively. Average UCVA was significantly better after LASIK at 1 day (20/26.8 vs. 20/50.4, P<0.0001) and 2 weeks (20/24.4 vs. 20/33.3, P = 0.0002) postoperatively. However, by 3 months postoperatively, UCVA was better after ASA (20/20.8 vs. 20/22.7, P = 0.05), and 81.5% of patients achieved 20/20 or better UCVA after ASA, compared with 70.5% after LASIK (P = 0.05). More ASA eyes had postoperative UCVA that achieved or surpassed preoperative BSCVA than LASIK eyes (66% vs. 41.6%, P<0.0001). There were 53 patients who underwent bilateral simultaneous ASA. By 1 week, 87.5% had 20/40 or better UCVA in at least one eye and 62.5% had 20/40 or better UCVA in both eyes. By 2 weeks, 86.8% had 20/40 or better UCVA in one eye and 82.6% had 20/40 or better UCVA in both eyes.
Conclusion
Initial visual recovery is more rapid after LASIK; however, by 3 months postoperatively UCVA and SE refractions were better after ASA. Advanced surface ablation is an effective alternative to LASIK, and based on early visual recovery, bilateral simultaneous surface ablation is a reasonable alternative to sequential surgery for the majority of patients.
1Department of Ophthalmology, Emory University, Atlanta, Georgia.
3Rollins School of Public Health at Emory University, Atlanta, Georgia.
Reprint requests to J. Bradley Randleman, MD, 1365 B Clifton Road NE, Suite 4500, Atlanta, GA 30322.
Manuscript no. 2006-937.
The authors have no financial interests in any of the products or topics mentioned in the article.
Supported in part by Research to Prevent Blindness, Inc., New York, New York, and the National Institutes of Health, Bethesda, Maryland (core grant no. P30 EYO6360).
⁎ Dr Banning is now in private practice in Kansas City, Kansas.
ABSTRACT