Topography-Guided vs Wavefront-Optimized Surface Ablation for Myopia Using the WaveLight Platform: A Contralateral Eye Study

PURPOSE: to compare treatments with wavefront-optimized and topography-guided ablations. METHODS: this prospective, randomized, contralateral study comprised 40 eyes (20 patients) with low to moderate myopia with or without astigmatism that underwent topography-guided photorefractive keratectomy (PRK) (ALLEGRO Topolyzer, Alcon Laboratories Inc) in one eye and wavefront-optimized PRK (ALLEGRETTO WAVE software version 2.020 default treatment, Alcon Laboratories Inc) in the fellow eye. Visual acuity, refractive error, contrast sensitivity, and Orbscan (Bausch & Lomb) 3- and 5-mm corneal irregularities were measured preoperatively and 3 and 6 months postoperatively. The results were compared between the two eyes. RESULTS: in both groups, preoperative corrected distance visual acuity (CDVA) (0.03±0.09 logMAR for topography-guided and 0.01 ± 0.06 logMAR for wavefront-optimized [P=.1]), 3-month postoperative uncorrected distance visual acuity (UDVA) (-0.0 1± 0.03 logMAR for topography-guided and -0.01 ± 0.03 logMAR for wavefront-optimized [P=.4]), and 6-month postoperative UDVA (0.01 ± 0.03 logMAR for topography-guided and 0.0 ± 0.01 logMAR for wavefront-optimized [P=.3]) were the same. All wavefront-optimized and 18 (90%) topography-guided eyes had UDVA of 20/20 or better. No significant differences were noted between groups in pre- and postoperative spherical and cylindrical refractive errors or corneal irregularity and contrast sensitivity measurements. Six months postoperatively, contrast sensitivity values at 3, 6, 12, and 18 cycles/degree were 5.7 ± 0.7, 6.0 ± 1.5, 6.1 ± 1.3, and 5.5 ± 1.5, respectively, in the topography-guided group, and 6.2 ± 0.6, 6.4 ±1.2, 6.4 ± 1.1, and 5.8 ± 1.3, respectively, in the wavefront-optimized group (P=.3, P=.5, P=.4, and P=.6, respectively). CONCLUSIONS: using the WaveLight excimer laser platform for PRK, CDVA and contrast sensitivity outcomes were statistically similar between the wavefront-optimized and topography-guided ablations in eyes with low to moderate myopia with and without astigmatism.