Customized LASIK treatment for myopia: relationship between preoperative higher order aberrations and refractive outcome

PURPOSE: To analyze the effect of preoperative higher order aberrations on postoperative sphere and cylinder outcome. METHODS: Three hundred thirty myopic eyes (mean: -3.32 +/- 1.54 diopters D], range: -1.0 to -7.0 D) treated with customized ablation using the Technolas 217z laser (Bausch & Lomb) were followed through 6 months after LASIK. Pre- and postoperative visual acuity, higher order root mean square (RMS), third order RMS, and spherical aberration were compared to study the safety and efficacy of the treatment. The relationship between preoperative higher order aberrations and manifest refraction after LASIK was analyzed. RESULTS: Following LASIK, 91.5% of eyes obtained an uncorrected visual acuity of > or = 20/20 and 70.3% of eyes obtained 20/16 without retreatment; 99% had a best spectacle-corrected visual acuity of > or = 20/20 (75.9% of eyes were within +/- 0.50 D). Mean value of significant increase in postoperative higher order aberrations was 0.12 +/- 0.18 microm (P<.0001). Increased spherical aberration was associated with increased myopia treatment (P<.0001). Greater positive spherical aberration after LASIK was significantly correlated to postoperative hyperopia (overcorrection). Change in third order RMS was significantly correlated to change in spherical equivalent refraction among eyes with postoperative astigmatism (P<.0001). CONCLUSIONS: With the Bausch & Lomb Technolas 217z Zyoptix software, treatment of higher order aberrations, especially third order (coma and trefoil) and spherical aberration, significantly improved postoperative refractive status.