Astigmatic Outcomes after Wavefront-Guided and Wavefront-Optimized Refractive Surgeries for Myopia with Low to Moderate Cylinder

Purpose: To compare the efficacy and accuracy of wavefront-guided (WFG) and wavefront-optimized (WFO) PRK and LASIK for the treatment of myopia with low to moderate astigmatism.Methods: In this prospective cohort study, 215 active duty military service members (430 eyes, mean spherical equivalent -3.61 ± 1.53 D) electing either PRK or LASIK were randomized to undergo WFG or WFO treatment. Up to 12 months, postoperative visual outcomes following surgeries were compared between 4 treatment groups: WFG PRK, WFG LASIK, WFO PRK, and WFO LASIK for myopia with 0.25 to 0.50 D astigmatism (≤ 0.50 D cyl subgroup) and ≥ 0.75 D astigmatism (≥ 0.75 D cyl subgroup). High and low contrast visual acuities were assessed and vector analysis was performed.Results: At 12 months postoperatively, the surgically induced astigmatism, magnitude of error, correction and flattening indices were significantly different between treatment groups (P values ≤ 0.001) in the ≤ 0.50 D cyl subgroup. In ≥ the 0.75 D cyl subgroup, there were no significant differences in vector analysis parameters except for the magnitude of error and correction index (P values ≤ 0.010). The treatment groups were comparable in terms of postoperative uncorrected distance visual acuity, manifest spherical equivalent, and best-corrected low contrast visual acuity.Conclusions: No treatment modality showed consistent superiority in correcting low to moderate astigmatism. Overall, both PRK and LASIK using either wavefront-guided or wavefront-optimized laser platforms were similarly effective and accurate in treating myopia with a low to moderate amount of astigmatism.