Wavefront-guided myopic laser in situ keratomileusis with a high-resolution Hartmann-Shack aberrometer and a new nomogram

Purpose To evaluate visual, refractive, aberrometric and patient-reported outcomes of wavefront-guided (WFG) myopic laser in situ keratomileusis (LASIK) using a high-resolution Hartmann-Shack aberrometer (iDesign Advanced WaveScan system, Johnson & Johnson Vision, Santa Ana, CA) with a new nomogram. The study was designed to determine if the new nomogram resolved the mild undercorrection that occurs with the manufacturer's default settings. Setting Three private LASIK practices. Design Prospective, open label, non-comparative, multicenter study. Methods One hundred ninety eyes of 95 patients underwent bilateral WFG LASIK for the correction of myopia or myopic astigmatism. A new nomogram was used, which effectively adjusted the wavefront-measured refraction sphere up or down to equal the manifest refraction sphere. Patients were followed for six months. Results Eighty-four patients completed final follow up. At 6 months, 96.4% (162/168) of eyes achieved monocular uncorrected distance visual acuity of 20/20 or better. No eye lost two or more lines of corrected distance visual acuity. The safety and efficacy indices were 1.12 and 1.09, respectively. 98% of eyes (164/168) had manifest refraction spherical equivalent within ±0.5 D of emmetropia and 92% (154/168) had residual manifest refractive astigmatism ≤0.5 D. Fewer patients experienced burning, stinging, soreness and irritation postoperatively than preoperatively. 96% (81/84) of patients reported improved quality of life. Conclusions WFG myopic LASIK using a high-resolution Hartmann Shack aberrometer and a new nomogram resolved the undercorrection with the manufacturer's default settings. The treatment was safe and effective with excellent visual and refractive outcomes, high patient satisfaction and improved quality of life.