Comparison of the 1st Generation and 3rd Generation Wavefront-Guided LASIK for the Treatment of Myopia and Myopic Astigmatism

Stephen J Hannan,1 David Teenan,1 Jan A Venter,1 Keith A Hettinger,1 Colin W Berry,1 Noelle C Hannan,1 Huba J Kiss,1 Dasi Raju,1 Julie M Schallhorn2,3 1Optical Express, Glasgow, United Kingdom; 2University of California, San Francisco, Department of Ophthalmology, San Francisco, CA, USA; 3F.I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USACorrespondence: Stephen J Hannan, Clinical Services Department, Optical Express, 200 St Vincent St, Glasgow, G2 5SG, United Kingdom, Tel +44 7740592389, Email StephenHannan@opticalexpress.comPurpose: To compare refractive, visual, and patient-reported outcomes associated with a 1st generation wavefront-guided (WFG) treatment with those associated with a 3rd generation WFG treatment.Patients and Methods: This retrospective study included patients who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) for myopia/myopic astigmatism. Two random stratified samples of patients who underwent either 1stgeneration (WaveScan, Johnson & Johnson Vision, Santa Ana, CA) or 3rd generation (iDesign 2.0, Johnson & Johnson Vision, Santa Ana, CA) treatment matched on preoperative refraction were compared (4290 eyes of 2145 patients in each group). One-month postoperative visual, refractive, and patient-reported outcomes were analyzed. Refractive and monocular visual acuity analyses were performed using one random eye of each patient.Results: The percentage of eyes achieving 20/20 or better uncorrected vision was 91.3% (1958/2145) in the 1st generation group and 95.9% (2056/2145) in the 3rd generation group (p< 0.01). Binocularly, the percentage of patients with 20/20 or better UDVA was 97.0% (2080/2145) and 99.2% (2127/2145) in the 1st and 3rd generation groups, respectively (p< 0.01). The mean postoperative MSE was − 0.01 ± 0.33 D in the 1st generation group and +0.19 ± 0.33 D in the 3rd generation group (p< 0.01). Postoperative refractive astigmatism had a mean value of − 0.20 ± 0.26 D and − 0.18 ± 0.24 D in the 1st and 3rd generation groups, respectively (p< 0.01). The mean correction index of refractive astigmatism was 1.09 ± 0.53 in the 1st generation group and 1.02 ± 0.38 in the 3rd generation group, p< 0.01. The overall percentage of patients satisfied with vision was 92.8% (1991/2145 patients) in the 1st generation group and 97.3% (2087/2145 patients) in the 3rd generation group (p< 0.01).Conclusion: For the majority of postoperative variables, there were significant differences between 1st and 3rd generation treatments. The 3rd generation treatments had better visual acuity outcomes and higher patient satisfaction.Keywords: wavefront-guided LASIK, myopia, aberrometer, refractive outcomes, patient-reported outcome