gms | German Medical Science

22nd International Congress of German Ophthalmic Surgeons

18. to 21.06.2009, Nürnberg

Wavefront-guided surgery is not for everybody!

Meeting Abstract

Search Medline for

  • Th. Seiler - IROC Institut Zürich, Zürich, Schweiz

22. Internationaler Kongress der Deutschen Ophthalmochirurgen. Nürnberg, 18.-21.06.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. Doc09docH 1a.8

doi: 10.3205/09doc005, urn:nbn:de:0183-09doc0050

Published: July 9, 2009

© 2009 Seiler.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



During wavefront guided LASIK or surface ablation in addition in to the refraktive error also some preexisting aberrations of the optical performance of the eye is treated. During the last years we have recognized that the correction of preexisting aberrations is not fully possible and in addition, using standard profiles spherical aberration is induced. Even using a wavefront-guided profile the rms-higer orders increased as the FDA points out in the premarket approval.

As an alternative, the wavefront-optimized profile has been developed that minimized on average the amount of induced spherical aberration and leaves practically the optical performance of the eye constant. In comparison studies under FDA-guidance it could be shown that in rmsh-errors of less than 0.3 µm the results regarding aberrations where identical to wavefront-guided treatments, however, in eyes with higher rmsh-errors wavefront-guided treatment was more beneficial compared to wave front optimized treatment.

Therefore, we believe that todays strategy should incorporate wavefront-optimized as well as wavefront-guided treatments but wavefront-guided treatments should be limited to eyes with a preoperative rmsh-value of more than 0.3 µm. The perrcentage of this patient group is in the normal refractive surgery practice in the order of 5–10 %.

To complete the picture it has to be mentioned that the refractive success rate of wavefront-guided treatments is worse than that of wavefront-optimized treatments. And the reason for that is that there are some interpendencies between spherical aberration and sphere and cornea with astigmatism which means that correcting a cornea may reduce the refractive success rate regarding astigmatism.

Regarding safety and efficacy we should use wavefront-guided treatment only in those cases where it is indicated to correct the preexisting wavefront error which means that this profile should be limited to a patient group of less than 10% in an average refractive practice.