Topography-modified refraction (TMR): adjustment of treated cylinder amount and axis to the topography versus standard clinical refraction in myopic topography-guided LASIK
Authors Kanellopoulos AJ
Received 14 September 2016
Accepted for publication 12 October 2016
Published 3 November 2016 Volume 2016:10 Pages 2213—2221
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Lucy Goodman
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Anastasios John Kanellopoulos1,2
1LaserVision Clinical and Research Institute, Athens, Greece; 2Department of Ophthalmology, NYU Medical School, New York, NY, USA
Purpose: To evaluate the safety, efficacy, and contralateral eye comparison of topography-guided myopic LASIK with two different refraction treatment strategies.
Setting: Private clinical ophthalmology practice.
Patients and methods: A total of 100 eyes (50 patients) in consecutive cases of myopic topography-guided LASIK procedures with the same refractive platform (FS200 femtosecond and EX500 excimer lasers) were randomized for treatment as follows: one eye with the standard clinical refraction (group A) and the contralateral eye with the topographic astigmatic power and axis (topography-modified treatment refraction; group B). All cases were evaluated pre- and post-operatively for the following parameters: refractive error, best corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), topography (Placido-disk based) and tomography (Scheimpflug-image based), wavefront analysis, pupillometry, and contrast sensitivity. Follow-up visits were conducted for at least 12 months.
Results: Mean refractive error was -5.5 D of myopia and -1.75 D of astigmatism. In group A versus group B, respectively, the average UDVA improved from 20/200 to 20/20 versus 20/16; post-operative CDVA was 20/20 and 20/13.5; 1 line of vision gained was 27.8% and 55.6%; and 2 lines of vision gained was 5.6% and 11.1%. In group A, 27.8% of eyes had over -0.50 diopters of residual refractive astigmatism, in comparison to 11.7% in group B (P<0.01). The residual percentages in both groups were measured with refractive astigmatism of more than –0.5 diopters.
Conclusion: Topography-modified refraction (TMR): topographic adjustment of the amount and axis of astigmatism treated, when different from the clinical refraction, may offer superior outcomes in topography-guided myopic LASIK. These findings may change the current clinical paradigm of the optimal subjective refraction utilized in laser vision correction.
Keywords: TMR, topography-modified refraction, myopic LASIK, femtosecond laser, FS200, EX500 excimer laser, long-term stability, regression, astigmatism correction, post-LASIK refraction
A Letter to the Editor has been received and published for this article.
This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.Download Article [PDF] View Full Text [HTML][Machine readable]