title: Outcomes of wavefront-optimized surface ablation.
abstract: OBJECTIVE
  To compare early visual outcomes after wavefront-optimized advanced surface ablation (ASA) with those after wavefront-optimized LASIK.
  
  
  METHODS
  Retrospective comparative series.
  
  
  METHODS
  One hundred thirty-six eyes undergoing ASA and 136 preoperative refraction-matched eyes undergoing LASIK from June 2004 through October 2005.
  
  
  METHODS
  Database review of preoperative characteristics, including patient age, gender, refraction, and central corneal pachymetry; perioperative information, including type of surgery, flap thickness (for LASIK cases), ablation depth, and residual stromal bed thickness; and postoperative information, including uncorrected visual acuity (UCVA) at 1 day, 1 week, 2 weeks, and 3 months, refraction at 3 months, and complications. All ASA patients had topical mitomycin C applied intraoperatively.
  
  
  METHODS
  Postoperative UCVA, best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) refraction, speed of visual recovery, and postoperative complications.
  
  
  RESULTS
  Surface ablation patients were younger (35.4 years vs. 39.8 years, P = 0.0002) and had thinner corneas (514 microm vs. 549 microm, P<0.0001) preoperatively. Average UCVA was significantly better after LASIK at 1 day (20/26.8 vs. 20/50.4, P<0.0001) and 2 weeks (20/24.4 vs. 20/33.3, P = 0.0002) postoperatively. However, by 3 months postoperatively, UCVA was better after ASA (20/20.8 vs. 20/22.7, P = 0.05), and 81.5% of patients achieved 20/20 or better UCVA after ASA, compared with 70.5% after LASIK (P = 0.05). More ASA eyes had postoperative UCVA that achieved or surpassed preoperative BSCVA than LASIK eyes (66% vs. 41.6%, P<0.0001). There were 53 patients who underwent bilateral simultaneous ASA. By 1 week, 87.5% had 20/40 or better UCVA in at least one eye and 62.5% had 20/40 or better UCVA in both eyes. By 2 weeks, 86.8% had 20/40 or better UCVA in one eye and 82.6% had 20/40 or better UCVA in both eyes.
  
  
  CONCLUSIONS
  Initial visual recovery is more rapid after LASIK; however, by 3 months postoperatively UCVA and SE refractions were better after ASA. Advanced surface ablation is an effective alternative to LASIK, and based on early visual recovery, bilateral simultaneous surface ablation is a reasonable alternative to sequential surgery for the majority of patients.
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, Georgia, USA. Jrandle@emory.edu
authors.forename: J Bradley
authors.initials: JB
authors.lastname: Randleman
authors.forename: Evan S
authors.initials: ES
authors.lastname: Loft
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Banning
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynn
authors.forename: R Doyle
authors.initials: RD
authors.lastname: Stulting
mesh_terms: D000328:Adult; D000477:Alkylating Agents / Q000008:administration & dosage; D003315:Cornea / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D049008:Keratectomy, Subepithelial, Laser-Assisted / Q000379:methods*; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D018903:Photorefractive Keratectomy / Q000379:methods*; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D013524:Surgical Flaps; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin