title: Wavefront-guided treatment of symptomatic eyes using the LADAR6000 excimer laser.
abstract: OBJECTIVE
  To evaluate the clinical results of wavefront-guided customized treatment of eyes that underwent previous keratorefractive surgery with clinically significant visual symptoms related to the presence of higher order aberrations, with or without defocus/astigmatism.
  
  
  METHODS
  Twenty-eight consecutive eyes of 19 symptomatic patients underwent wavefront-guided custom photorefractive keratectomy (PRK with mitomycin C) to correct low and high order aberrations, using the LADAR-Vision platform. All eyes had manifest refractive spherical equivalent (MRSE) error from 0.00 to -4.25 diopters (D), and high order aberrations root-mean-square (RMS) values >0.80 microm for a 6.0-mm measurement diameter (mean: 1.18 microm). Eyes were examined at 1, 3, and 6 months postoperatively. Uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), MRSE, wavefront measurement of high order aberrations, and patient subjective evaluation were the parameters used to assess the treatment.
  
  
  RESULTS
  Six months after treatment, all 28 eyes had an improvement in UCVA compared to preoperative values. Seventeen (60.7%) eyes gained lines of BSCVA (1 to 3 lines) whereas 1 eye lost 1 line. Although the amount of positive defocus was intentionally and empirically undercorrected in this study, MRSE was slightly hyperopic (mean +0.65 D, range: -0.25 to +1.75 D). All eyes showed a reduction in pre-existing high order aberrations, with a mean reduction of 47% (0.62 microm). Spherical aberration reduced the most (mean 60%), coma was reduced by a mean 29%, and all other terms were reduced by a mean 42% compared to preoperative values. Subjectively, all patients but 1 (both eyes treated) noticed a reduction in their pre-existing visual symptoms. Overall, the treatment was considered satisfactory by the patients in terms of visual quality gain.
  
  
  CONCLUSIONS
  This series of consecutive treatments of symptomatic eyes indicates wavefront-guided custom ablation is an effective surgical option to reduce visually impairing high order aberrations and related visual symptoms. To avoid the resulting hyperopic shift, some significant nomogram adjustments are necessary, most often when pre-existing positive spherical aberration is present.
authors.affiliation: Carones Ophthalmology Center, Milan, Italy. fcarones@carones.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Carones
authors.forename: Luca
authors.initials: L
authors.lastname: Vigo
authors.forename: Elena
authors.initials: E
authors.lastname: Scandola
mesh_terms: D000328:Adult; D001251:Astigmatism / Q000601:surgery*; D003315:Cornea / Q000601:surgery*; D019781:Corneal Topography / Q000379:methods; D005260:Female; D006801:Humans; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D018903:Photorefractive Keratectomy / Q000379:methods*; D054140:Refractive Surgical Procedures; D012086:Reoperation; D016896:Treatment Outcome; D014792:Visual Acuity