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Wavefront Guided LASIK Surgery: Does It Really Work?

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Abstract

The most commonly performed refractive procedure worldwide to correct myopia, hyperopia and astigmatism is Laser Assisted In-Situ Keratmileusis (LASIK). In this procedure, a thin flap of tissue is created at the anterior surface of the cornea, retracted, and an excimer laser is used to deliver the appropriate ablation pattern to treat the ametropia of the eye. The corneal flap is then repositioned, leaving an altered corneal anterior surface which provides excellent uncorrected visual acuity for the treated eye. Recent advances in technology have allowed the adaptation of Hartmann-Shack wavefront measurement techniques to the human eye. Population measurements have identified significant higher order wavefront aberrations in the human eye, particularly with pupil sizes of the magnitude that are present under low illumination conditions. The energy delivery format of many excimer lasers used in refractive surgery as low energy pulses over a small area with high repetition frequencies makes this platform an ideal technology to attempt to correct the higher order wavefront aberration present in the preoperative human eye because of the ability to ablate non-rotationally symmetrical patterns with higher frequency spatial changes than a conventional myopic treatment. Several companies have therefore developed LASIK treatments which are designed to correct the preoperative wavefront aberrations of the individual eye, and this procedure is known as wavefront guided LASIK. Calculation of the actual treatment profile is relatively easy, but ensuring that the lateral and rotational alignment of this treatment is maintained from the diagnostic instrument through to the laser surgical procedure has required additional technology development. Eye trackers are used in conjunction with the laser delivery system to ensure that each pulse is fired at the correct spatial location on the cornea. Iris information captured at the time of diagnostic acquisition is transferred to the laser and compared to the position of the eye when the patient is in position under the laser and the orientation and spatial location of the treatment is compared and altered as necessary. The clinical results of wavefront guided LASIK have demonstrated a reduction in postoperative higher order aberrations compared to a conventional myopic treatment, and this has been associated with better postoperative visual performance than previous treatments, indicating that in the majority of cases, wavefront guided LASIK provides a superior outcome to conventional LASIK procedures.

© 2005 Optical Society of America

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