Objective and subjective preoperative refraction techniques for wavefront-optimized and wavefront-guided laser in situ keratomileusis

Purpose: To determine which of 3 methods for measuring preoperative refractive error yields the best refractive outcomes after wavefront-guided (Visx Star S4) or wavefront-optimized (WaveLight Allegretto Wave) excimer laser in situ keratomileusis (LASIK). Setting: Emory Eye Center and Emory Vision, Emory University, Atlanta, Georgia, USA. Methods: This retrospective analysis of LASIK, performed from June to December 2007, analyzed sphere, cylinder, and spherical equivalent (SE) refractions generated from 3 methods (manifest refraction, aberrometer autorefraction [CustomVue WaveScan], corneal analyzer autorefraction [Nidek ARK-10000 OPD]), actual programmed treatment, and absolute deviation from ideal treatment (deviation) for each technique. Results: In the wavefront-guided group (63 eyes, 33 patients), manifest refraction and aberrometer autorefraction generated similar deviation for sphere and SE; both were significantly better than corneal analyzer autorefraction (P = .02 and P = .03, respectively). Aberrometer autorefraction generated less cylinder deviation than the other methods (both P = .003). In the wavefront-optimized group (61 eyes, 36 patients), manifest refraction generated less deviation for sphere and SE than aberrometer autorefraction or corneal analyzer autorefraction (sphere: P = .005 and P = .009, respectively; SE: P = .005 and P = .002, respectively). Manifest refraction and aberrometer autorefraction cylinder generated similar deviation, while aberrometer autorefraction was less than corneal analyzer autorefraction (P = .041). Conclusions: Overall, manifest refraction was most accurate in generating postoperative emmetropia with both laser treatments; however, aberrometer autorefraction produced the least cylinder deviation for wavefront-guided treatment. Corneal analyzer autorefraction produced the least accurate results with both lasers. [Copyright &y& Elsevier]