A comparison of wavefront-optimized and wavefront-guided ablations

PURPOSE OF REVIEW: Optimized aspherical as well as custom wavefront-guided treatments attempt to reduce the induction of visually disturbing aberrations than can occur with conventional spherocylindrical corneal ablation. This review highlights a comparison of the advances and limitations of the two treatments. RECENT FINDINGS: Optimized aspherical as well as wavefront-guided corneal excimer laser treatments have continued to improve in outcomes compared with conventional treatments. Wavefront-guided as well as wavefront-optimized treatments yield high predictability, efficacy, and safety. Equally good vision has been obtained as measured by snellen acuity, patient questionnaires, and total residual higher-order aberrations. Wavefront-guided treatments did have better results in spherical aberration, coma as well as contrast sensitivity outcomes. Surgeons who have easy access to both technologies suggest using wavefront-optimized treatments in 67-88% of patients and reserve wavefront-guided treatments for those who have above average higher-order aberrations. However, even with individually adjusted aspheric, 'Q' values, optimized ablations still increased higher-order aberrations and wavefront-guided treatments also did not achieve the elimination of residual higher-order aberrations. SUMMARY: Optimized aspheric corneal ablations that attempt to avoid reducing the prolate eccentricity of the average cornea as well as wavefront-guided treatments that attempt to reduce the individual whole-eye aberrations have continued to improve visual outcomes compared with conventional treatments.