Wavefront-Guided LASIK

What is Wavefront-Guided LASIK?

Wavefront-guided LASIK is a customized LASIK procedure, also known as custom LASIK. Conventional LASIK primarily treats your refractive error, which you can think of as the numbers on your eyeglass prescription. Wavefront-guided technology corrects refractive errors along with minor irregularities in your visual system, called higher-order aberrations.

Higher-order aberrations are light-related distortions in your vision. They can occur in your cornea, which is the clear covering in front of your eye.

Higher-order aberration symptoms include:

  • Halos or starbursts around lights
  • Glare
  • Ghosting or shadows in your vision
  • Poor contrast sensitivity
  • Difficulty seeing in low light conditions

In contrast, your refractive error is an example of a lower-order aberration.

Lower-order aberrations include:

  • Myopia (nearsightedness), which is when you are unable to see at a distance.
  • Hyperopia (farsightedness), which is when you have difficulty seeing at near.
  • Astigmatism, which is when you have an irregularly shaped eye. Your eye shape is similar to an egg, versus round like a ball. Astigmatism causes difficulty seeing at distance and near.

Correcting higher-order aberrations can deliver better visual clarity than correcting lower-order aberrations alone. Patients who have a significant amount of higher-order aberrations may be candidates for a wavefront-guided procedure. 

Lower-order aberrations make up 90 percent of all aberrations in your eye, while higher-order aberrations make up about 10 percent.

What is a wavefront?

If you imagine multiple rays of light, the wavefront is a surface perpendicular to corresponding points on each of these light rays. 

Wavefront-Guided LASIK Procedure Overview

  1. Before LASIK, your eye surgeon will use an instrument called a wavefront aberrometer to take measurements of your eye. 

  2. First, the wavefront aberrometer sends a beam of light through your eye. The light travels through your cornea and lens. These structures in your eye are naturally clear and help focus light, but may contain higher-order aberrations.

  3. The light reflects off your retina, which is the tissue lining the back of your eye. Then, the aberrometer measures the reflected wavefront as it travels back to the front of your eye.

  4. The wavefront aberrometer uses this information to generate a 3D wavefront map, which includes any aberrations. A wavefront map is as unique as your fingerprint. 

  5. Your eye surgeon uses this map to customize your LASIK treatment. Wavefront-guided LASIK will correct your vision while minimizing any existing higher-order aberrations in your corneas. 

  6. The wavefront-guided LASIK procedure may take slightly longer than a conventional LASIK surgery, but the recovery time is similar

How Much Does Wavefront-Guided LASIK Cost?

Wavefront-guided LASIK usually costs more than conventional LASIK. If your surgeon combines wavefront-guided LASIK with a bladeless LASIK procedure, this can increase the cost further. An average range for LASIK is $4,000 to $5,000 for both eyes. A conventional, non-bladeless LASIK procedure may cost less. 

Advantages and Disadvantages

Wavefront-guided LASIK is excellent technology that many patients are eligible for. However, there are some drawbacks to consider.

Advantages of Wavefront-Guided LASIK:

  • Higher-quality vision. Wavefront-guided LASIK minimizes higher-order aberrations, giving patients sharper vision after surgery, compared to conventional LASIK.
  • Suitable for larger pupils. A common concern with conventional LASIK is that patients with larger pupils may experience more night vision problems. The symptoms include halos, glare, and reduced contrast sensitivity. Studies find that with wavefront-guided technology, pupil size does not have a significant impact on these side effects.
  • Suitable for subtle visual distortions. For patients who have existing higher-order aberrations before LASIK, wavefront-guided technology is an excellent option. These patients may have subtle corneal irregularities that glasses or contacts cannot correct.

Disadvantages of Wavefront-Guided LASIK:

  • May not suit older patients. Your cornea and lens are clear structures in your eye that help focus light. As we age, the lens develops into a cataract. The wavefront aberrometer may then pick up aberrations in the lens as opposed to the cornea. This is not ideal for a wavefront-guided LASIK procedure since the goal is to correct irregularities in the cornea.
  • Requires accurate aberrometer results. Since a wavefront-guided procedure requires exact measurements, not everyone is a candidate. For example, the aberrometer may not capture a high-quality measurement on someone with a corneal scar or who has lens implants from cataract surgery. If the aberrometer cannot take accurate readings, this error can cause more higher-order aberrations.
  • May leave less possibility for touch-ups. Since the procedure adjusts for corneal irregularities, you may have thinner corneas after surgery than with conventional LASIK. This means a lower potential for a second LASIK procedure in the future.
  • Limited treatment range. Diopters (D) are the units used to measure your eyeglass prescription. Wavefront-guided technology is approved to treat about 7.0 D of myopia, 3.0 D of astigmatism, and 3.0 D of hyperopia. The majority of patients fall into this prescription range and can receive wavefront-guided treatment. However, patients with higher prescriptions require an alternative form of LASIK, such as wavefront-optimized.
Icon of a person versus another person

Wavefront-Guided LASIK Versus Wavefront-Optimized LASIK

Though the names are similar, wavefront-guided and wavefront-optimized are two different LASIK procedures. Wavefront-guided technology is more sophisticated and customized.

You can think of wavefront-optimized as an improved conventional LASIK procedure. Just like conventional LASIK, wavefront-optimized LASIK relies mainly on your eyeglass prescription to correct your vision. However, wavefront-optimized surgery uses advanced computer software to deliver a better visual outcome compared to conventional LASIK. 

Here are some important points to know about wavefront-guided and wavefront-optimized LASIK:

  • Wavefront-guided and wavefront-optimized LASIK both use advanced software, which guides the laser to reshape the periphery of your cornea. This helps to minimize post-surgical aberrations.
  • Studies find most patients have minimal amounts of higher-order aberrations, especially at a younger age. These patients would do well with either a wavefront-guided or wavefront-optimized procedure.
  • If a patient does have pre-existing higher-order aberrations, wavefront-guided LASIK is the better option. 
  • You can think of wavefront-guided LASIK as minimizing pre- and post-surgical aberrations, while wavefront-optimized LASIK mainly prevents post-surgical aberrations.
  • Wavefront-optimized procedures are faster than wavefront-optimized LASIK.

Overall, research shows both types of LASIK deliver excellent visual outcomes. However, wavefront-guided LASIK generally yields better visual results, with fewer aberrations post-surgically.

Author: Melody Huang, O.D. | UPDATED April 21, 2020

Resources

Chan, Annie, and Edward E. Manche. “Effect of Preoperative Pupil Size on Quality of Vision after Wavefront-Guided LASIK.” Ophthalmology, vol. 118, no. 4, Apr. 2011, pp. 736–741., doi:10.1016/j.ophtha.2010.07.030.

Machat, Jeffery J. “Evolution of the Wavefront-Guided Laser.” Cataract & Refractive Surgery Today, May 2015, www.crstoday.com/articles/2015-may/evolution-of-the-wavefront-guided-laser/.

Moshirfar, Majid, et al. “Meta-Analysis of the FDA Reports on Patient-Reported Outcomes Using the Three Latest Platforms for LASIK.” Journal of Refractive Surgery, vol. 33, no. 6, 1 June 2017, pp. 362–368, doi:10.3928/1081597x-20161221-02. 

Roe, Joshua R., and Edward E. Manche. “Prospective, Randomized, Contralateral Eye Comparison of Wavefront-Guided and Wavefront-Optimized Laser in Situ Keratomileusis.” American Journal of Ophthalmology, vol. 207, 4 June 2019, pp. 175–183, doi:10.1016/j.ajo.2019.05.026.

Stephenson, Michelle. “Wavefront-Guided VS. Wavefront-Optimized Laser Treatments.” EyeWorld Online, ASCRS Ophthalmic Services, 30 June 2017, www.eyeworld.org/wavefront-guided-vs-wavefront-optimized-laser-treatments.

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