Authors' objectives:

The purpose of this report is to assess the usefulness of wave front analysis in the diagnosis and management of refractive defects.

Authors' results and conclusions: The simplest and safest way to correct refractive defects is by prescribing eye glasses or contact lenses. Refractive surgery is an alternative method intended to provide better comfort to the patient while avoiding the use of external optical tools, but the correction achieved does not exceed and, in many cases, is lower than that provided by eye glasses and lenses. That is why refractive surgical procedures are not considered medically necessary by many world health organizations. When deciding on refractive surgery, there are several techniques and, basically, there is no evidence coming from prospective randomized trials that one technique is better than the other. The most widely used is LASIK and with the coming up of wave front analysis technology, LASIK may be personalized by using aberrometer guidance. In 2002, Nuijts et al conducted a randomized prospective trial with 12 patients, comparing conventional LASIK versus wave front guided LASIK for the correction of low to moderate myopia after 6 months. Both methods showed an excellent safety rate. With front wave guided LASIK ablation depth was significantly lower, though the efficacy rate was slightly lower as compared to conventional LASIK. In 2003, Phusitphoykai et al compared conventional versus wave front guided LASIK. Twenty short-sighted eyes (10 patients) were randomized to undergo wave front guided ablation in the first eye and conventional ablation in the other. They concluded that the visual result with both procedures was not significantly different. Other studies compared the wave front with the conventional methods as regards induction of post surgical aberrations showing that, in general, a smaller number of higher order aberrations were found with personalized ablation methods. In terms of visual acuity, patient preferences and contrast sensitivity, personalized ablation sometimes resulted in slightly but not statistically significant better results. Several studies showed that the reproducibility of the measurement of higher-order aberrations was low thus restricting result interpretation.

Authors' recommendations: The added value of higher order aberration correction using wave front guided surgical methods is difficult to assess as regards their clinical impact. Even though it is still necessary to keep doing research on this new technology, it is possible that a selected subgroup of patients had more benefits with this technique: Patients with high rate of refractive defect due to these higher order aberrations, retreatment of already operated patients presenting persisting symptoms attributable to higher order aberrations detected on aberrometry or those patients requiring visual acuities or contrast sensitivity higher than normal, either due to their occupation or to a significant individual sensitivity.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)