Refractive Surgery/Vision Correction

Topography-Guided Custom Ablation Not as Accurate as Wavefront-Optimized Ablation

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Topography-guided custom ablation in virgin eyes induced less corneal optical path difference, higher-order aberrations, and coma, but was not as accurate as wavefront-optimized ablation, according to a new study in the Journal of Refractive Surgery. Specifically, the study examined outcomes between topography-guided customized ablation treatment (TCAT) and wavefront-optimized (WFO) LASIK in myopic patients.

The prospective randomized contralateral study included 432 eyes of 216 myopic patients who underwent LASIK. TCAT was randomly performed in one eye and WFO LASIK in the other. The WaveLight FS200 femtosecond laser (Alcon Laboratories, Inc., Fort Worth, TX) was used to create the flap and the EX500 excimer laser was used for photoablation. Refractive and visual outcomes and corneal aberrations were compared between groups.

At 1-month follow-up, uncorrected distance visual acuity was 20/20 or better in 89.4% of eyes in the TCAT group and 93.5% of eyes in the WFO group (P < .05). Corrected distance visual acuity and residual manifest refractive spherical equivalent were similar between groups (P > .05). The optical path difference and root mean square of higher-order aberrations and coma were significantly lower in eyes in the TCAT group at 1- and 6-month follow-up (P < .05).

Ultimately, TCAT was not as accurate as WFO LASIK.


Zhang Y, Chen Y. A randomized comparative study of topography-guided versus wavefront-optimized fs-lasik for correcting myopia and myopic astigmatism. J Refract Surg. 2019;35(9):575–582. doi: 10.3928/1081597X-20190819-01.

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