Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided and Topography-Guided Laser In Situ Keratomileusis

To compare the visual outcomes of eyes treated with ocular wavefront-guided (OWFG) LASIK versus topography-guided (TG) LASIK. Byers Eye Institute at Stanford University; Stanford, CA, USA. Prospective, randomized, contralateral eye-controlled trial. Treatments were randomized according to ocular dominance. This study treated patients with myopia or compound myopic astigmatism with OWFG-LASIK (planned using the iDesign Advanced WaveScan Studio System aberrometer, Johnson & Johnson Vision, Inc.) in 1 eye and TG-LASIK (planned using the Contoura Vision and WaveLight Topolyzer Vario, Alcon Laboratories, Inc.) in the fellow eye from January 2023 to April 2024. Postoperative evaluation was performed at 1, 3, 6, and 12 months post-operation and consisted of visual acuity, manifest refraction, 5% and 25% low-contrast visual acuity, and higher-order aberrations (coma, trefoil, spherical aberration). One hundred eyes of 50 patients with myopia or compound myopic astigmatism were enrolled in the study and underwent successful treatments. Ninety-six eyes of 48 patients completed 12 months of follow-up. At post-operative month 12, there were no statistically significant differences between the OWFG-LASIK and TG-LASIK groups for spherical equivalent, (p > 0.05); higher order aberrations, including coma, trefoil, and spherical aberrations (p > 0.05); proportion of eyes that had ≥20/20 UDVA (100% in the OWFG-LASIK group vs 98% in the TG-LASIK group); or proportion of eyes that had improved 5% and 25% low-contrast visual acuity. Eyes randomized to OWFG-LASIK had a significant greater percentage of eyes achieving UDVA of 20/12.5 compared to TG-LASIK (p = 0.003). Ocular wavefront-guided LASIK and topography-guided LASIK achieve similar refractive results with excellent clinical outcomes and excellent predictability in both groups.