eMedicine Specialties > Ophthalmology > Refractive Disorders

Astigmatism, LASIK: Follow-up

Author: David R Hardten, MD, Phillips Eye Institute; Adjunct Clinical Associate Professor, Director of Refractive Surgery at Minnesota Eye Consultants, Pennsylvania College of Optometry; Clinical Associate Professor, Department of Ophthalmology, University of Minnesota, Minnesota VAMC
Coauthor(s): Ahmad M Fahmy, OD, Fellow, Department of Ophthalmology, Minnesota Eye Consultants; Scott G Hauswirth, OD, Consulting Staff, Department of Optometry, Minnesota Eye Consultants
Contributor Information and Disclosures

Updated: Jan 2, 2007

Outcome and Prognosis

Astigmatic correction results using the excimer laser steadily have improved as surgical techniques have improved. Several years ago, Nordan et al reported a series of 5 eyes with postkeratoplasty anisometropia treated with the excimer laser. The mean preoperative myopia was -7.40±4.37 D with a mean of +3.05±1.47 D of astigmatism. Postoperatively, the myopia was reduced to a mean of -3.35±3.04 D, and the astigmatism was reduced to +1.30±0.60 D. The improvement in refractive error also was associated with an improvement in uncorrected visual acuities. Thirteen eyes with high astigmatism were treated with a rotating mask system using the Aesculap Meditec MEL 193-nm excimer laser. In this study, the astigmatism was reduced an average of 2.80 D. Inadequate correction was seen in some patients due to decentration of the ablation. Haze was seen in most patients but was graded as severe in only 2 patients and eventually cleared with topical steroids.

The ability of the excimer laser to treat high levels of astigmatism in all degrees of myopia also was examined by Lee et al. One hundred ten eyes were included in the study with myopic spherical component ranging from -3.00 D to -13.00 D, and astigmatic component ranging from -2.00 D to -5.50 D. All ablations were completed with an elliptical and multizone treatment pattern. Results were examined using vector analysis and showed that the low-to-moderate levels of myopia had a high level of predictability. However, high levels of myopia, greater than -10.25 D, showed little improvement in astigmatic correction in this study.

The authors' group reported a series of 19 eyes undergoing LASIK for hyperopic astigmatism. Preoperative average hyperopia was +2.20 D±0.99, and cylinder corrections ranged from 0 D to 4.50 D. Postoperatively, no eyes lost more than 2 lines of best-corrected visual acuity, and 63% of eyes were within +1.00 D of emmetropia. In the eyes with the longest follow-up care (6 mo), refractive stability was good, although it was still unclear if the slight tendency for the primary hyperopes to regress would continue over the long term. In both groups, however, predictability was good, and patients gained excellent uncorrected visual acuity quickly after surgery. This suggests that LASIK may help hyperopic astigmatic patients resume a normal, active lifestyle after only a brief recovery period.

Another study by this group looked at the results of LASIK for myopic astigmatism and compared unilateral and bilateral treatments. The procedure rapidly reduced spherical equivalent and astigmatism in both groups. No statistical difference in spherical equivalent or astigmatism was noted postoperatively between groups. The effect of LASIK on the astigmatism was rapid and remained stable without regression between the visits at 1 day and 1 month and between visits at 1 month and 1 year in both the unilateral (p=1, p=0.94) and bilateral groups (p=0.14, p=0.45). The difference in cylinder between the unilateral and bilateral groups was not statistically significant at any of the postoperative visits.

Another study by Febbraro et al examined the efficacy of excimer laser photoastigmatic refractive keratectomy in patients treated with a Nidek EC 5000 excimer laser. Preoperative myopia averaged -4.50 D, and average astigmatism preoperatively was -1.64 D. Results at 1 year showed residual subjective astigmatism to be -0.40 D. Uncorrected visual acuity of 20/40 or better occurred in 22 out of 27 eyes and 21 of the eyes were within ± -1.00 D of emmetropia.

In a study by Vinciguerra et al, 25 eyes underwent correction for hyperopic astigmatism using the excimer laser with an algorithm designed to remove as little tissue as possible. Mean preoperative hyperopia was +3.76±1.70 D, and mean preoperative cylinder was 2.20±0.80 D. Six month follow-up results showed that mean sphere was corrected by 3.08 D and mean cylinder by 1.60 D, while best-corrected visual acuity actually improved.

As is clearly demonstrated, PRK and LASIK are predictable and effective means of correcting various types and degrees of ametropia, including astigmatism.

Future and Controversies

The excimer laser is now frequently used to correct astigmatism. Although early results appear promising, whether the excimer laser procedure will completely replace incisional astigmatic keratotomy awaits to be seen. Complications are unusual and if managed appropriately, a minimal incidence of losing best-corrected visual acuity exists. Thorough understanding of the corneal response to both incisional astigmatic surgery as well as excimer laser correction of astigmatism is essential to refractive surgeons. As these responses are better understood and as software packages are refined, more success using excimer laser techniques is expected.

Continued advancements in many areas of refractive surgery are improving results obtained in correction of astigmatism. The excimer laser used to resculpt the cornea under a corneal flap in the LASIK procedure is currently the most reliable method of correcting astigmatism. Proper attention to surgical details as well as preoperative and postoperative management will continue to provide safe and reliable astigmatic corrections.

 


More on Astigmatism, LASIK

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Follow-up: Astigmatism, LASIK
Multimedia: Astigmatism, LASIK
References
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Further Reading

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Keywords

LASIK, astigmatism, PRK, PARK, refractive error, refraction, photoastigmatic refractive keratectomy, conventional laser in-situ keratomileusis, wavefront-guided laser in-situ keratomileusis, wavefront-guided LASIK, photorefractive keratoplasty, laser epithelial keratomileusis, LASEK, astigmatic keratotomy

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Contributor Information and Disclosures

Author

David R Hardten, MD, Phillips Eye Institute; Adjunct Clinical Associate Professor, Director of Refractive Surgery at Minnesota Eye Consultants, Pennsylvania College of Optometry; Clinical Associate Professor, Department of Ophthalmology, University of Minnesota, Minnesota VAMC
David R Hardten, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology, American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Alcon, Allergan, AMO, TLCVision, STAAR, Kolis, Ophtec Grant/research funds Other

Coauthor(s)

Ahmad M Fahmy, OD, Fellow, Department of Ophthalmology, Minnesota Eye Consultants
Ahmad M Fahmy, OD is a member of the following medical societies: American Academy of Optometry and American Optometric Association
Disclosure: Nothing to disclose.

Scott G Hauswirth, OD, Consulting Staff, Department of Optometry, Minnesota Eye Consultants
Scott G Hauswirth, OD is a member of the following medical societies: International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Daniel S Durrie, MD, Director, Department of Ophthalmology, Division of Refractive Surgery, University of Kansas Medical Center
Daniel S Durrie, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Louis E Probst, MD, Medical Director of Refractive Surgery, Chicago, Madison, Milwaukee, and Windsor Centers, TLC the Laser Eye Centers
Louis E Probst, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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