Meta-Analysis of Wavefront-Guided vs. Wavefront-Optimized LASIK for Myopia

Purpose. To detect possible differences in clinical outcomes between wavefront-guided laser in situ keratomileusis (LASIK) and wavefront-optimized LASIK for the treatment of myopia. Methods. A comprehensive literature search of Cochrane Library, MEDLINE, and EMBASE to identify relevant trials comparing LASIK with wavefront-guided and wavefront-optimized. A meta-analysis was performed on the results of the reports. Statistical analysis was performed using RevMan 5.0 software. Results. Seven articles describing a total of 930 eyes were identified. There were no statistically significant differences in the final proportion of eyes achieving uncorrected distance visual acuity of 20/20 or better [odds ratio, 1.04; 95% confidence interval (CI), 0.66 to 1.65; p = 0.86], manifest refractive spherical equivalent within ± 0.50 D of the target (odds ratio, 0.96; 95% CI, 0.53 to 1.75; p = 0.90). No patient lost ≥2 lines of distance-corrected visual acuity at posttreatment. The changes in higher order aberrations were not statistically significant different between the two groups with preoperative root-mean-square (RMS) higher order aberrations <0.3 &mgr;m (weighted mean difference, 0.01; 95% CI, −0.02 to 0.04; p = 0.57). However, wavefront-guided had a significant better postoperative aberration profile than wavefront-optimized with preoperative RMS higher order aberrations >0.3 &mgr;m (weighted mean difference, −0.10; 95% CI, −0.15 to −0.06; p < 0.00001). Conclusions. Both wavefront-guided and wavefront-optimized LASIK have shown excellent efficacy, safety, and predictability. The wavefront-guided technology may be a more appropriate choice for patients who have preoperative RMS higher order aberrations >0.3 &mgr;m.