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LASIK with optimized aspheric profiles may correct high myopia
Am J Ophthalmol. 2011;152(6):954-963.
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LASIK performed with a new-generation excimer laser and optimized aberration-free ablation profiles succeeded in treating high myopia, a study found.
"These results contrast with several previous studies reporting the very low predictability of LASIK procedure in high refractive errors," the study authors said. "The refractive outcomes that we have obtained today treating high levels of myopia are similar to those reported for low to moderate myopia in the last decade, and possibly these outcomes will become even better in the future with the upcoming advances in excimer laser technology."
The retrospective study included 51 eyes of 32 patients with at least 8.5 D spherical equivalent of myopia or myopic astigmatism who underwent LASIK with the sixth-generation Amaris excimer laser (Schwind). The IntraLase femtosecond laser (Abbott Medical Optics) was used to create LASIK flaps. ORK-CAM software (Schwind) was used to design optimized aspheric aberration-free ablation profiles.
Mean preoperative spherical equivalent was -8.66 D. Four eyes underwent re-treatment.
Study results showed an average gain in logMAR uncorrected distance visual acuity of 15 lines at 3 months; the improvement was statistically significant (P < .01).
Best corrected distance visual acuity stabilized or improved in 98% of eyes at 3 months. One eye lost one line of best corrected distance visual acuity.
Spherical equivalent improved significantly (P < .01). Postoperative spherical equivalent was within 0.5 D of emmetropia in 84.3% of eyes; 90.2% of eyes had postoperative spherical equivalent within 1 D of emmetropia.
Further study of LASIK for high myopia with larger patient groups is warranted, the researchers said.
The authors’ results are impressive but the follow-up is short. This paper would carry more weight if it was prospective. Phakic IOL results are around for up to 12 years, so a direct comparison is not valid. Contrary to the citation that stability occurs at 3 months, younger patients with high myopia undergo significant myopic progression over longer term. In many of these patients it will not be possible to re-treat with laser. They may require phakic IOLs. With the risk of post-LASIK ectasia, and with a significant deficit in our knowledge, performing LASIK on high myopes up to 12 D should only be performed as part of a prospective study. Phakic IOLs have an excellent track record and have a much longer follow-up, and they are increasingly recognized as the operation of choice for high myopia.
– Michael J. O’Keeffe, FRCS
Mater
Misericordiae Hospital, Dublin, Ireland
Disclosure: Dr. O’Keeffe has
no relevant financial disclosures.