title: Efficacy, predictability, and safety of wavefront-guided refractive laser treatment: metaanalysis.
abstract: OBJECTIVE
  To compare the efficacy, predictability, safety, and induced higher-order aberrations (HOAs) between wavefront-guided and non-wavefront-guided ablations.
  
  
  METHODS
  Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, United Kingdom.
  
  
  METHODS
  Metaanalysis.
  
  
  METHODS
  The Cochrane Central Register of Controlled Trials, PubMED, and EMBASE were searched for randomized controlled trails. Trials meeting the selection criteria were quality appraised and data extracted by 2 independent authors. Measures of association were pooled quantitatively using metaanalytical methods. Comparison between wavefront-guided and non-wavefront-guided ablations was measured as pooled odds ratios (ORs) or weighted mean differences. The pooled ORs and 95% confidence intervals (CIs) were computed for efficacy, safety, and predictability. The weighted mean difference and 95% CIs were used to compare induced HOAs.
  
  
  RESULTS
  Eight trials involving 955 eyes were included. After wavefront-guided LASIK, the pooled OR of achieving uncorrected distance visual acuity (UDVA) of 20/20 (efficacy) was 1.10 (95% CI, 0.66-1.83; P=.72), the pooled OR of achieving a result within ± 0.50 diopter of intended target (predictability) was 1.03 (95% CI, 0.60-1.75; P=.92), and the weighted mean difference in induced HOAs was -0.09 (95% CI, -0.17 to -0.01; P=.04). No study reported loss of 2 or more lines of Snellen acuity (safety) with either modality.
  
  
  CONCLUSIONS
  Metaanalysis showed no clear evidence of a benefit of wavefront-guided over non-wavefront-guided ablations. However, there was a lack of standardized reporting of UDVA better than 20/20, which might mask an advantage in wavefront-guided treatment. With high preexisting HOAs, wavefront-guided has advantages over non-wavefront-guided treatment.
authors.affiliation: Division of Ophthalmology and Visual Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Usama
authors.initials: U
authors.lastname: Fares
authors.forename: Hanif
authors.initials: H
authors.lastname: Suleman
authors.forename: Mouhamed Ali
authors.initials: MA
authors.lastname: Al-Aqaba
authors.forename: Ahamd Muneer
authors.initials: AM
authors.lastname: Otri
authors.forename: Dalia G
authors.initials: DG
authors.lastname: Said
authors.forename: Harminder S
authors.initials: HS
authors.lastname: Dua
mesh_terms: D001251:Astigmatism / Q000503:physiopathology / Q000601:surgery; D057108:Corneal Wavefront Aberration / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D006956:Hyperopia / Q000503:physiopathology / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ / Q000009:adverse effects / Q000379:methods*; D054018:Lasers, Excimer / Q000009:adverse effects / Q000627:therapeutic use*; D009216:Myopia / Q000601:surgery*; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012029:Refraction, Ocular / Q000502:physiology; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology