Patients report improved quality of life after wavefront-guided LASIK
Risks, potential outcomes and postoperative course should all be discussed preoperatively.
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Bilateral wavefront-guided LASIK provided excellent visual outcomes and high patient satisfaction as measured with the Refractive Status and Vision Profile questionnaire, according to a prospective case series reported in the Journal of Cataract and Refractive Surgery.
“The RSVP questionnaire also measures patient quality of life,” study co-author Edward E. Manche, MD, told Ocular Surgery News. “In our study, we found that quality of life, as measured with the questionnaire, improved significantly. Patients noted improvements in visual function and perception, as well as decreased problems with corrective lenses.”
The prospective cohort study included 84 eyes of 42 patients who underwent bilateral wavefront-guided LASIK using the Visx Star S4 IR CustomVue excimer laser system (Johnson & Johnson Vision) performed by Manche at the Stanford Eye Laser Center. Each treatment was personalized with a target for emmetropia, and all flaps were developed using a 150 kHz Intralase iFS femtosecond laser (Johnson & Johnson Vision).
Outcomes at 1 year
Primary outcome was RSVP score at 12 months, and secondary outcomes were visual acuity, refractive error and aberrometric measurements, all measured preoperatively and then again at 1, 6 and 12 months after surgery.
At the study endpoint, all eyes achieved at least 20/40 uncorrected distance visual acuity (UDVA), and 76 eyes achieved 20/20 or better. There were nonsignificant increases in the percentage of eyes achieving 20/40 or better corrected distance visual acuity at 12 months postoperatively compared with baseline.
Preoperatively, 73.8% of patients said they were satisfied with their near vision. That percentage decreased to 69% at 12 months. However, patient satisfaction with their vision without correction preoperatively was 4.76%, which increased to 88.1% at 12 months.
“It is important to closely follow patients in the postoperative period to make sure that their healing process is proceeding smoothly,” Manche said. “Many patients have transient symptoms in the early postoperative course, such as fluctuating vision, night vision phenomena and dry eye. The treating physician needs to manage any issues such as dry eye and keep patients informed of the expected postoperative recovery period. Well-educated patients know what to expect and are less alarmed during the healing process.”
Before surgery, all patients needed glasses, contact lenses or both. At 1 year after surgery, no patients reported the need for corrective lenses. Additionally, 99% of eyes were within 0.5 D spherical equivalent 12 months postoperatively and 90% achieved a UDVA of 20/20 or better.
Improved RSVP scores
Total RSVP improved significantly at all time points from baseline. Total RSVP preoperatively was 30.9 compared with 20.7 at 12 months postoperatively (P < .001). The RSVP scores for visual function, perceptions and problems with corrective lenses all statistically significantly improved from baseline to 12 months postoperatively.
Driving and visual symptoms were the only two RSVP parameters that did not statistically significantly improve from baseline to 12 months.
“Wavefront LASIK has excellent efficacy, predictability and safety. In our study, all subjects had an uncorrected visual acuity of 20/40 or better, 91% of eyes were 20/20 or better, and 64% of eyes were 20/16 or better. There have been a number of studies which have shown that patient satisfaction is highly correlated with uncorrected distance visual acuity. The high percentage of eyes with excellent visual acuity is one of the primary reasons for such high patient satisfaction,” Manche said.
Modern LASIK surgery using wavefront-guided technology is an “excellent option” for patients considering alternatives to glasses and contact lenses, according to Manche, who said it is important to have a thorough preoperative discussion with patients.
“Patients have to understand the risks, potential outcomes and postoperative course before agreeing to have surgery. It is important to understand the patient’s motivation for having LASIK surgery. Patients also need to understand what LASIK surgery can and can’t do for their visual needs,” he said. – by Robert Linnehan
- Reference:
- Chen SP, et al. J Cataract Refract Surg. 2019;doi:10.1016/j.jcrs.2018.12.013.
- For more information:
- Edward E. Manche, MD, can be reached at Byers Eye Institute, Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA 94303; email: edward.manche@stanford.edu.
Disclosure: Manche reports he has equity in RxSight and Vacu-Site; has patents with Vacu-Site; has received funding for sponsored research from Alcon Laboratories, Allergan, Avedro, Carl Zeiss Meditec, Johnson & Johnson Vision Care, Ocular Therapeutics and Presbia; and is a consultant to Allergan, Avedro, Carl Zeiss Meditec, Johnson & Johnson Vision Care and Shire.