Comparison of visual performance between conventional LASIK and wavefront-guided LASIK with iris-registration

BACKGROUND: Laser in situ keratomileusis (LASIK) has become an efficient and commonly performed procedure to reduce refractive errors. In order to further increase the postoperative visual quality, the wavefront-guided refractive surgery has been a research hotspot in customized surgery. This study was conducted to compare the visual acuity, higher-order aberration, and contrast sensitivity of wavefront-guided LASIK with iris-registration and conventional LASIK. METHODS: Two hundred and eleven myopic eyes of 109 patients were enrolled in this prospective study and randomly divided into two groups: the wavefront-guided LASIK (wg LASIK) group (94 eyes) and conventional LASIK group (117 eyes). A Wavescan Wavefront aberrometer was used to analyze Zernike coefficients and the root-mean-square (RMS) of higher order aberrations with 6.0 mm pupil size, and Optec 6500 visual function instrument was used to measure contrast sensitivity (CS) under 5 spatial frequencies before and after surgery in both groups. RESULTS: The uncorrected visual acuity (UCVA) and the mean spherical equivalent (SE) in wg LASIK group were significantly better than those in conventional LASIK (UCVA, z = 2.339, P = 0.019; SE, t = 2.838, P = 0.005) at 3 months after surgery. Moreover, the increase in Z(3)(-3), Z(3)(1), Z(3)(3), Z(4)(0), Z(5)(-1), Z(5)(1), Z(5)(5) and Z(6)(-6) in wg LASIK group was statistically smaller than that in conventional LASIK group (P < 0.05). In wg LASIK group, eyes with a higher amount of the preoperative RMS of the higher order aberrations (RMSh = 0.30 microm) showed a statistically lower increase (13.5%) than those in conventional LASIK group at 3 months after surgery (33.3%) (P = 0.004). And the values of 4th order spherical aberration (4thSA) and the root mean square of 6th order aberration (RMS6) in wg LASIK group were significantly lower than those in conventional group in eyes which had higher preoperative astigmatism (= 1.0D) (4thSA, P = 0.03; RMS6, P = 0.02). Wg LASIK group showed better CS values than the correspondingly preoperative values at all spatial frequencies with and without glare at 3 months after the surgery while conventional LASIK group displayed reduced CS values except for 1.5 and 3 cycles per degree with glare. The differences between the two groups were statistically significant (P < 0.001). CONCLUSIONS: Wavefront-guided LASIK with iris-registration is efficient to reduce higher order aberrations especially spherical and coma aberrations, and to improve postoperative visual acuity and contrast sensitivity compared with conventional LASIK. The application of wavefront-guided LASIK with iris-registration is particularly suitable for eyes with higher preoperative RMSh values and eyes with higher preoperative astigmatism.