Optical factors in increased best spectacle-corrected visual acuity after LASIK

PURPOSE: To study the factors that correlate with improved best spectacle-corrected visual acuity (BSCVA) after LASIK. METHODS: This was a nonrandomized, prospective clinical trial of 850 eyes from 480 patients undergoing LASIK for myopia, hyperopia, and mixed astigmatism. The mean preoperative spherical equivalent refraction was -3.75 +/- 4.82 diopters (D) (range: -13.88 to 6.00 D). From this population, 72 eyes (including 22 amblyopic eyes) from 43 patients were found to have improved BSCVA 6 months after LASIK. All patients underwent LASIK with the NAVEX platform. These eyes were analyzed to evaluate factors that correlated with improved BSCVA.,Pre- and postoperative BSCVA, refraction, pupil diameter, corneal topography, asphericity (Q value), total aberrations, and higher order wavefront aberrations were analyzed. All wavefront aberrations were measured using the NIDEK Optical Path Difference Scan aberrometer (OPD-Scan) preoperatively and at 6 months postoperatively. RESULTS: Postoperatively, the mean sphere was -0.44 +/- 1.30 D (range: -4.50 to +2.50 D). The mean increase in BSCVA was 0.15 +/- 0.09 logMAR. A statistically significant negative correlation was observed between the increase in BSCVA and the preoperative BSCVA (P < .01). Mixed astigmatic and highly myopic eyes are more likely to gain BSCVA after LASIK than moderately myopic (P < .05) and hyperopic eyes (P < .001). In patients with myopia, the amount of BSCVA improvement correlated with the magnitude of the correction (P < .05). The induction of spherical aberration negatively correlated with the increase in BSCVA (P < .05). There were no significant differences between normal eyes and amblyopic eyes with respect to postoperative improvement in BSCVA (P > .05). CONCLUSIONS: Decreased preoperative BSCVA, lower total spherical aberration induction, and preoperative mixed astigmatism and high myopia correlate with an increase in BSCVA after LASIK.