Comparison of Visual Outcome After Hyperopic LASIK Using a Wavefront-Optimized Platform Versus Other Excimer Lasers in the Past Two Decades

Background: Laser-assisted in-situ keratomileusis (LASIK) for the correction of hyperopia and hyperopic astigmatism is challenging and has been less studied than for the correction of myopia and myopic astigmatism. The aim of this study was to analyze the refractive outcomes of LASIK in hyperopia and hyperopic astigmatic eyes using a wave-front optimized laser platform (the Allegretto EX500 laser) and perform a historical comparison with other excimer lasers within the past two decades.

Hypothesis: We hypothesized that there have been significant improvements in LASIK treatment for hyperopia and hyperopic astigmatism in the past two decades, in part due to wave-front optimized laser platforms.

Methods: A one-center (Tertiary Refractive Center, Draper, Utah), retrospective, non-comparative study was conducted on 379 eyes treated with LASIK for hyperopia and hyperopic astigmatism. The data retrieved on these eyes were analyzed using uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalents. A literature search of excimer platforms in use in the past 20 years and a comparison of US Federal Drug Administration-approved platforms for hyperopia were performed.

Results: At 3 and 12 months postoperatively, 142 (66%) and 81 (69%) eyes had a UDVA of 20/20 or better and 207 (96%) and 114 (97%) eyes had a UDVA of 20/40 or better, respectively. The mean refractive spherical equivalent was - 0.52 ± 0.78 D at 3 months and - 0.46 ± 0.79 D at 12 months. At 12 months, 181 (96%) eyes achieved a spherical equivalent within ± 1.00 D of the intended target. Studies published before 2005 reported lower rates of UDVA 20/20 or better (32%) compared to those published after (68%); however, this discrepancy was less evident for UDVA 20/40 or better. A similar trend towards improved accuracy was noted in the literature with postoperative manifest refractive spherical equivalent within ± 0.50 D before and after 2005.

Conclusions: There has been significant improvement in safety, efficacy, stability, and accuracy of LASIK treatment for hyperopia and hyperopic astigmatism within the past two decades. Newer excimer lasers meet industry standards and in particular, the Allegretto EX500 used in this study exceeded industry standards.

Source of mentor’s funding or other support that funded this research: none