Astigmatism induced by conventional spherical ablation after PRK and LASIK in myopia with astigmatism < 1.00 D

Steven M Christiansen,¹ Mark D Mifflin,¹ Jason N Edmonds,¹ Rachel G Simpson,² Majid Moshirfar<sup>1

1</sup>John A Moran Eye Center, University of Utah, Salt Lake City, UT, ²The University of Arizona College of Medicine, Phoenix, AZ, USA

Background: The purpose of this study was to evaluate surgically-induced astigmatism after spherical ablation in photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) for myopia with astigmatism < 1.00 D.
Methods: The charts of patients undergoing spherical PRK or LASIK for the correction of myopia with minimal astigmatism of <1.00 D from 2002 to 2012 at the John A Moran Eye Center in Salt Lake City, UT, were retrospectively reviewed. Astigmatism was measured by manifest refraction. The final astigmatic refractive outcome at 6 months postoperatively was compared with the initial refraction by Alpins vector analysis.
Results: For PRK, average cylinder increased from 0.39 ± 0.25 (0.00–0.75) preoperatively to 0.55 ± 0.48 (0.00–1.75) postoperatively (P = 0.014), compared with an increase in LASIK eyes from 0.40 ± 0.27 (0.00–0.75) preoperatively to 0.52 ± 0.45 (0.00–2.00) postoperatively (P = 0.041). PRK eyes experienced an absolute value change in cylinder of 0.41 ± 0.32 (0.00–1.50) and LASIK eyes experienced a change of 0.41 ± 0.31 (0.00–1.50, P = 0.955). Mean surgically-induced astigmatism was 0.59 ± 0.35 (0.00–1.70) in PRK eyes, with an increase in surgically-induced astigmatism of 0.44 D for each additional 1.00 D of preoperative cylinder; in LASIK eyes, mean surgically-induced astigmatism was 0.55 ± 0.32 (0.00–1.80, P = 0.482), with an increase in surgically-induced astigmatism of 0.29 D for each 1.00 D of preoperative cylinder.
Conclusion: Spherical ablation can induce substantial astigmatism even in eyes with less than one diopter of preoperative astigmatism in both PRK and LASIK. No significant difference in the magnitude of surgically-induced astigmatism was found between eyes treated with PRK and LASIK, although surgically-induced astigmatism was found to increase with greater levels of preoperative astigmatism in both PRK and LASIK.

Keywords: surgically-induced astigmatism, ablation, photorefractive keratectomy, laser-assisted in situ keratomileusis