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What is Wavefront
Guided LASIK?
What is wavefront technology?
How are the aberrations described
mathematically?
What is the regulatory status of
Wavefront Guided LASIK?
Who is a candidate for Wavefront
Guided LASIK?
Why is Wavefront Guided LASIK more
expensive?
What are the latest results with
Wavefront Guided LASIK?
What are the long-term results with
Wavefront Guided LASIK?
Who is NOT a candidate for Wavefront
Guided LASIK?
Wavefront Guided LASIK s a variation of LASIK
surgery which uses "wavefront"
technology to custom sculpt the cornea to
correct vision. Wavefront Guided LASIK may, in
certain situations, provide better results than
traditional LASIK.
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 Over
the last few years, much research has been done
in the area of "adaptive optics," which
is the technique of removing blurring in images
caused by distortions in optical systems. The
field of astronomy has benefited greatly in this
manner-new telescopes use microscopically adjusting
mirrors and lenses to compensate for optical irregularities,
enhancing the quality of the image received.
Ophthalmologists have looked at using this technology
to improve
laser vision correction techniques. The eye
is basically an optical system with lenses (the
cornea and the actual lens inside the eye both
function as lenses).
Wavefront technology measures optical aberrations
or distortions in the eye's optical system, and
mathematically describes and quantifies these
aberrations. Linking this information to a small-spot
scanning laser like the LADARVision allows us
to custom-sculpt the cornea and potentially correct
these distortions.
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Zernike polynomials are mathematical descriptions
of aberrations in vision. There are different
"orders" or levels of polynomials. The
low-level polynomials describe nearsightedness,
farsightedness, and astigmatism, which are aberrations
easily treated with glasses, or with traditional
LASIK.
Higher-order polynomials are more recently described
aberrations which affect vision, like coma, trefoil
and spherical aberration. There are over a dozen
higher-order aberrations--this chart graphically
depicts some of the more common higher-order aberrations.
Wavefront Guided LASIK or wavefront-based LASIK
can treat higher-order aberrations.
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The FDA Ophthalmic Devices Panel unanimously recommended
approval for the Alcon
LADARVision Custom Cornea wavefront-guided laser
vision correction system in October of 2002.
It is currently F.D.A. approved. The approval
is for myopia between 0 and -7 diopters with 0.5
diopters or less of astigmatism. Alcon is the
first laser manufacturer to gain approval for
this technology.
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There are two general groups of patients who may
benefit from this technology. First, any patient
looking for LASIK who is in the proper range of
correction, who wants to benefit from the correction
of these optical aberrations, may be a candidate.
There is evidence
that shows Wavefront Guided LASIK treatments deliver
sharper postop vision and fewer nighttime side
effects than traditional LASIK. Amount of correction,
corneal thickness, and general eye health are
factors taken into consideration when planning
treatment.
A second group of patients who may benefit tremendously
from this technology are those who have already
had LASIK, PRK, LASEK, or other refractive surgeries
and are having some troubles. Problems such as
nighttime glare, halos, quality of vision issues,
and even simply residual refractive error may
be eliminated with Wavefront Guided LASIK. Factors
like corneal thickness and general eye health
are important in determining candidacy.
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The equipment needed to measure and describe higher
order optical aberrations (the wavefront measuring
device) is expensive.
Additionally, the laser manufacturer imposes
additional royalties for the use of the technology
in performing Wavefront Guided LASIK.
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CustomCornea wavefront-guided LASIK using the
Alcon LADARVision4000 laser and the LADARWave
system is now approved for use. The latest FDA
data shows that wavefront-guided treatments using
this system provide superior visual results compared
to traditional LASIK treatments.
In the latest study, 141 eyes were treated and
postoperatively, 63% saw 20/16 or better without
glasses. 88% saw 20/20 or better. This data is
with a single surgery, without any retreatments
(enhancements).
Looking at eyes with no astigmatism (45 eyes),
results are even better, with 71% seeing 20/16
or better and 93% seeing 20/20 or better.
Accuracy of corrections was also extremely impressive,
with 90% of eyes ending up within 0.5 diopter
of the intended correction.
Regarding night vision, only 1.4% of patients
reported significant worsening of night vision;
nearly ten times more patients (11.3%) reported
significant improvement of their night
vision after treatment!
Click here
to read the visual acuity data at 3 months postop
for the first 59 eyes treated by Dr. Kawesch using
wavefront-guided LASIK.
Click here
to see the results of 38 patients surveyed at
3 months postop after treatment by Dr. Gary Kawesch
using wavefront-guided LASIK .
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Since it is so new, we do not have long term data
on the results. We don't know if higher-order
optical aberrations change as people grow older,
or if they remain stable. We do have a 10+ year
history with traditional LASIK, and anticipate
custom LASIK will provide equally good, if not
better long term results.
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Patients with corneas that are too thin may not
be able to have Wavefront Guided LASIK. Some patients
may not see much of a benefit from this technology
compared to traditional LASIK. Part of our job
is to help determine as best we can who would
benefit the most from this technology, and recommend
it strongly to those patients.
Learn the facts you need to know about Custom
Cornea® LASIK surgery
Read a study of the safety and effectiveness of
the LADARVision 4000 Excimer Laser System
Read an article from the Wall Street Journal about
how the wavefront technique is being used to reduce
the flaws in laser eye surgery
CNN.com: The Next Generation of Laser Eye Surgery
 Read
what this recent wavefront patient and others
have to say about the results of their surgery
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