title: Wavefront-guided versus wavefront-optimized photorefractive keratectomy: Clinical outcomes and patient satisfaction.
abstract: OBJECTIVE
  To compare visual outcomes following Visx Star S4 Customvue wavefront-guided and Allegretto Wave Eye-Q 400 Hz wavefront-optimized photorefractive keratectomy (PRK).
  
  
  METHODS
  Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir, Virginia, and Walter Reed National Military Medical Center, Bethesda, Maryland, USA.
  
  
  METHODS
  Prospective randomized clinical trial.
  
  
  METHODS
  Active-duty United States military soldiers were randomized to have wavefront-guided (Visx Star S4 Customvue) or wavefront-optimized PRK. Participants were followed up to 12 months postoperatively. Primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and manifest spherical equivalent (SE). Secondary outcome measures included refractive astigmatism, higher-order aberrations (HOAs), contrast sensitivity, subjective visual complaints, and patient satisfaction.
  
  
  RESULTS
  The study evaluated 108 soldiers (mean age 30.3 years ± 6.3 [SD]; mean manifest SE -3.51 ± 1.63 D). At 12 months postoperatively, achieved UDVA, CDVA, manifest SE, and refractive astigmatism were comparable between wavefront-guided and wavefront-optimized groups (P > .213). Spherical aberration and total HOAs significantly increased from baseline in both groups (P < .006). The change in coma, trefoil, spherical aberration, and total HOAs (P > .254) were comparable between groups. There were fewer losses of photopic low-contrast visual acuity (LCVA) at 5% contrast after wavefront-guided compared to wavefront-optimized treatment (P = .003). There was no significant difference between treatment groups in visual symptoms, overall vision expectation, and satisfaction (P > .075).
  
  
  CONCLUSIONS
  Wavefront-guided treatment offered a small advantage in photopic LCVA. Refractive outcomes, HOAs, self-reported visual difficulties, overall vision expectation, and satisfaction were otherwise comparable between wavefront-guided and wavefront-optimized treatments.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: rosekristine.c.sia.ctr@mail.mil.
authors.forename: Rose K
authors.initials: RK
authors.lastname: Sia
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Denise S
authors.initials: DS
authors.lastname: Ryan
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Stutzman
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Pasternak
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Eaddy
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Lorie A
authors.initials: LA
authors.lastname: Logan
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Torres
authors.affiliation: From the Warfighter Refractive Eye Surgery Program and Research Center at Fort Belvoir (Sia, Ryan, Eaddy, Logan), Fort Belvoir, Virginia, the Ophthalmology Service (Stutzman, Pasternak), Walter Reed National Military Medical Center, Bethesda, Maryland, the Ophthalmology Service (Torres), Madigan Army Medical Center, Tacoma, Washington, and the Wilmer Eye Institute (Bower), Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Kraig S
authors.initials: KS
authors.lastname: Bower
mesh_terms: D057128:Aberrometry; D000328:Adult; D001251:Astigmatism / Q000503:physiopathology; D015350:Contrast Sensitivity / Q000502:physiology; D057108:Corneal Wavefront Aberration / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008887:Military Medicine; D008889:Military Personnel; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D018903:Photorefractive Keratectomy / Q000379:methods*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology; D014481:United States; D014792:Visual Acuity / Q000502:physiology*; D055815:Young Adult