A Randomized Comparative Study of Topography-Guided Versus Wavefront-Optimized FS-LASIK for Correcting Myopia and Myopic Astigmatism

PURPOSE: To compare clinical outcomes between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) laser in situ keratomileusis (LASIK) in fellow eyes of myopic patients. METHODS: This prospective randomized contralateral study included 432 eyes of 216 myopic patients who underwent LASIK. TCAT was randomly performed in one eye (TCAT group) and WFO LASIK in the fellow eye (WFO group). The WaveLight FS200 femtosecond laser (Alcon Laboratories, Inc., Fort Worth, TX) was used to create the flap and the EX500 excimer laser was used for photoablation. The Sirius combined corneal topographer and tomographer system (CSO, Florence, Italy) was used to measure the corneal aberrations. Refractive and visual outcomes and corneal aberrations were compared between the two groups. RESULTS: At 1 month postoperatively, the uncorrected distance visual acuity (UDVA) was 20/20 or better in 89.4% of eyes in the TCAT group and 93.5% of eyes in the WFO group ( P < .05). The UDVA became similar at postoperative 6 months ( P > .05). Postoperative corrected distance visual acuity and residual manifest refractive spherical equivalent were similar between the groups ( P > .05). The postoperative residual refractive astigmatism in the TCAT group was greater than that in the WFO group ( P < .05). The optical path difference and root mean square of higher order aberrations and coma were significantly lower in eyes in the TCAT group at postoperative 1 and 6 months ( P < .05). CONCLUSIONS: TCAT in virgin eyes induced less corneal optical path difference, fewer higher order aberrations, and less coma than WFO LASIK. However, TCAT was not as accurate as WFO, especially in astigmatism correction. A better compensation method for TCAT is warranted. [ J Refract Surg. 2019;35(9):575–582.]