Factors Predicting Slow Visual Recovery Following Myopic Photorefractive Keratectomy

Purpose: To identify factors predicting slow visual recovery following photorefractive keratectomy (PRK). Methods: This retrospective study included consecutive patients who underwent PRK between January 2005 and December 2019 at Care Vision Laser Center, Tel Aviv, Israel. Myopic patients were divided into 2 groups according to whether they experienced normal recovery of visual acuity (within 60 days) or slow visual recovery (>60 days). Visual recovery was defined as achieving an efficacy index of 0.9 or greater. Efficacy index was calculated as postoperative uncorrected visual acuity/preoperative best corrected visual acuity. A comparison of baseline and intraoperative parameters was performed. Binary logistic regression was performed to identify potential predictors of slow visual recovery. Results: Overall, 4868 eyes were included. The mean age was 25.9 ± 7.7 years, and 53.9% were male. The slow visual recovery group (39.3%, n = 1911/4868) was older ( P < 0.001) and had greater refractive astigmatism ( P < 0.001) with a larger proportion of recent contact lens wearers ( P = 0.002). The slow recovery group had larger optic zone treatments ( P < 0.001), alcohol-assisted PRK (vs. transepithelial PRK) ( P < 0.001), and greater maximum ablation depth ( P < 0.001). In binary logistic regression, older age ( P < 0.001), higher refractive astigmatism ( P = 0.01), recent contact lens wear ( P = 0.01), greater optic zone treatment ( P = 0.001), and alcohol-assisted PRK ( P < 0.001) remained significant predictors of slow visual recovery. Conclusions: Slow visual recovery was observed in ∼40% of patients following myopic PRK. Older age, greater refractive astigmatism, recent contact lens wear, greater optic zone treatment, and alcohol-assisted PRK were associated with slow visual recovery.