A retrospective analysis of visual outcomes in laser vision correction of hyperopic patients using the VISX STAR S4 IR® and the WaveLight® EX500 excimer laser platforms
Nitz, Michael Allen
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BACKGROUND: Laser vision correction (LVC) developed as a more permanent alternative to other forms of refractive error correction. In the last several decades, visual outcomes of corneal refractive surgeries like LVC have improved dramatically with the discovery of new technologies and techniques designed to make the patient experience more comfortable and worthwhile. LVC has been shown to safely and effectively treat refractive errors in myopic and hyperopic eyes, with gradually improving outcomes and safety measures. However, it is important to note whether specific excimer lasers impart the same level of safe, effective treatments for patients as technology advances. OBJECTIVE: This study aims to identify whether any statistically significant difference exists in the visual and refractive outcomes of hyperopic laser vision correction using two excimer laser platforms, the VISX STAR S4 IR® and the WaveLight® EX500, and to determine whether either laser shows any statistically significant difference in the rate of repeat surgery within one year post-operatively. METHODS: Using EMR data collected from December 2008 through December 2016, distance and near visual acuity outcomes for hyperopic eyes treated with LASIK, LASEK, or PRK were compared at one month and up to one year post-operatively. Distance eyes were compared separately from monovision (near-targeted) eyes for visual acuity; however, if manifest refraction post-operative data were available, they were used to identify whether any difference existed in the refractive outcomes in either category. The number of enhancements (repeat surgeries) was also tabulated. X2 Tests of Independence were used to determine statistical significance. RESULTS: Visual acuity outcomes in distance eyes at one month post-operatively showed similar trends between the two lasers, with 54% of the 267 VISX- and 60% of the 119 EX500-treated eyes presenting with UCVA of 20/20 or better. Eyes available for follow-up within one year post-operatively kept with this trend; 98 (51%) VISX- and 58 (67%) EX500-treated, eyes had UCVA measured at 20/20 or better. For monovision (treated for reading vision) eyes, 29 (47%) eyes and 19 (54%) of VISX- and EX500-treated eyes, respectively, read J1+ by one month post-operatively. By one year, 16 (39%) and 3 (21%) of available eyes read J1+ after treatment with the VISX and EX500 respectively. The relative enhancement rate was 7.82% (28 eyes) on the VISX and 4.19% (7 eyes) on the EX 500. CONCLUSION: Overall, visual outcomes of laser vision correction for hyperopic patients did not differ consistently between the two lasers. Only distance-treated eyes measured up to one year post-operatively showed a statistically significant difference between the two lasers. The visual and, more importantly, the refractive outcomes were statistically similar at both one month and up to one year post-operatively irrespective of treatment type. Enhancement rate between the two lasers also showed no differences. Both lasers are similarly safe and effective for treating hyperopia and hyperopic astigmatism.
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