Advanced corneal surface ablation efficacy in myopia: changes in higher order aberrations

Objective: To evaluate the change of ocular and corneal higher order aberrations (HOAs) after wavefront-guided advanced surface ablation (WF-ASA) for myopia using 4 different epithelial management techniques (AA-PRK, LASEK, Epi-PRK, and Epi-LASIK).Design: Retrospective single centre excimer database analysis.Participants: Two hundred and forty eyes equally divided between the 4 WF-ASA techniques, matched for mean and range of required spherical correction.Methods: Ocular wavefront aberrations were measured using the wavescan aberrometer and corneal aberrations were obtained from corneal topography elevation maps and calculated by ray-tracing. All data were collected preoperatively and 3 months following treatment. The aberrations were described as Zernike polynomials, and analysis focused on total HOAs and spherical aberration (SA).Results: Three months postoperatively, there was a statistically significant surgically induced increase in total HOAs and SA both for ocular and corneal analysis (p < 0.001). There was no statistically significant difference in the induced ocular SA and HOAs between the groups, but the differences in induced corneal SA and HOAs were significant (p = 0.010). Ocular changes in SA were weakly correlated to preoperative SA (−0.30, p < 0.001) but strongly correlated to applied spherical correction (−0.68, p < 0.001). Surgically induced corneal SA was weakly correlated to preoperative corneal SA (−0.34, p < 0.001) and applied spherical correction (−0.46, p < 0.001).Conclusions: Three months postoperatively, all procedures resulted in an increase in ocular and corneal HOAs and SA. Induced aberrations were most strongly correlated to the applied spherical power correction. Modifying the existing ablation pattern to compensate for induced HOAs might improve the outcome.