Laser Eye Surgery for Vision Correction: A Review of Clinical Effectiveness and Guidelines [Internet]

Refractive error (ametropia) is a common condition resulting in decreased visual acuity. Patients are treated and symptoms can be corrected with eyeglasses, contact lenses, or surgery. Eyeglasses are the simplest and safest means of refractive error correction. Laser eye surgeries are a subset of surgical procedures used to correct most common refractive errors and are the most frequently performed procedures for low to moderate near-sightedness (myopia). Photorefractive keratectomy (PRK), was developed over 20 years ago, and subsequently wavefront-guided laser in situ keratomileusis (LASIK) has become the most commonly performed keratorefractive procedure. Other procedures are variations of PRK and include laser epithelial keratomileusis (LASEK) and epi-LASIK. Long term studies demonstrate excellent safety, efficacy, and stability of these procedures with long term refractive stability for far-sighted (hyperopic) patients less certain than for myopic patients.Some concern remains regarding the stability of post-surgical refractive error which is reflected in post-surgical waiting periods for refractive surgery patients applying for some occupations with visual acuity requirements in Canada. This report aims to retrieve and review the clinical effectiveness evidence for laser eye surgery as compared to eyeglasses and no treatment for patients with new vision correction requirements and those with unstable visual acuity requiring a change to current refractive correction. Additionally, this report aims to retrieve and review evidence-based guidelines associated with laser eye surgery for first responders and patients with occupational requirements for high visual acuity.