Outcomes of wavefront-optimized surface ablation

Ophthalmology. 2007 May;114(5):983-8. doi: 10.1016/j.ophtha.2006.10.048. Epub 2007 Mar 6.


Purpose: To compare early visual outcomes after wavefront-optimized advanced surface ablation (ASA) with those after wavefront-optimized LASIK.

Design: Retrospective comparative series.

Participants: One hundred thirty-six eyes undergoing ASA and 136 preoperative refraction-matched eyes undergoing LASIK from June 2004 through October 2005.

Methods: Database review of preoperative characteristics, including patient age, gender, refraction, and central corneal pachymetry; perioperative information, including type of surgery, flap thickness (for LASIK cases), ablation depth, and residual stromal bed thickness; and postoperative information, including uncorrected visual acuity (UCVA) at 1 day, 1 week, 2 weeks, and 3 months, refraction at 3 months, and complications. All ASA patients had topical mitomycin C applied intraoperatively.

Main outcomes measures: Postoperative UCVA, best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SE) refraction, speed of visual recovery, and postoperative complications.

Results: Surface ablation patients were younger (35.4 years vs. 39.8 years, P = 0.0002) and had thinner corneas (514 microm vs. 549 microm, P<0.0001) preoperatively. Average UCVA was significantly better after LASIK at 1 day (20/26.8 vs. 20/50.4, P<0.0001) and 2 weeks (20/24.4 vs. 20/33.3, P = 0.0002) postoperatively. However, by 3 months postoperatively, UCVA was better after ASA (20/20.8 vs. 20/22.7, P = 0.05), and 81.5% of patients achieved 20/20 or better UCVA after ASA, compared with 70.5% after LASIK (P = 0.05). More ASA eyes had postoperative UCVA that achieved or surpassed preoperative BSCVA than LASIK eyes (66% vs. 41.6%, P<0.0001). There were 53 patients who underwent bilateral simultaneous ASA. By 1 week, 87.5% had 20/40 or better UCVA in at least one eye and 62.5% had 20/40 or better UCVA in both eyes. By 2 weeks, 86.8% had 20/40 or better UCVA in one eye and 82.6% had 20/40 or better UCVA in both eyes.

Conclusion: Initial visual recovery is more rapid after LASIK; however, by 3 months postoperatively UCVA and SE refractions were better after ASA. Advanced surface ablation is an effective alternative to LASIK, and based on early visual recovery, bilateral simultaneous surface ablation is a reasonable alternative to sequential surgery for the majority of patients.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Alkylating Agents / administration & dosage
  • Cornea / physiopathology
  • Cornea / surgery*
  • Female
  • Humans
  • Keratectomy, Subepithelial, Laser-Assisted / methods*
  • Keratomileusis, Laser In Situ / methods*
  • Lasers, Excimer
  • Male
  • Mitomycin / administration & dosage
  • Myopia / physiopathology
  • Myopia / surgery*
  • Photorefractive Keratectomy / methods*
  • Postoperative Complications
  • Recovery of Function
  • Retrospective Studies
  • Surgical Flaps
  • Treatment Outcome
  • Visual Acuity / physiology


  • Alkylating Agents
  • Mitomycin