Pippa Wysong

May 02, 2006

May 2, 2006 (Fort Lauderale) -- Laser-assisted in-situ keratomileusis (LASIK) and laser-assisted subepithelial keratectomy (LASIK) have similar efficacy in correcting moderate myopia, according to findings from the Airforce Warfighter Refractive Surgery Study.

Findings from the large study, which was a head-to-head comparison of the procedures, were presented here at the annual meeting of the Association for Research in Vision and Ophthalmology by Richard Fergusen, Jr., MD, from the Brooke Army Medical Center in San Antonio, Texas.

In the study, a total of 1310 eyes of 655 patients from both the US Army and the Air Force underwent treatment with refractive surgery. A total of 668 eyes of 342 patients were treated with LASIK, and 662 eyes of 331 patients were treated with LASEK using the VISX Star laser platform. Patients were recruited to the study from February 2001 to 2004.

At baseline, manifest spherical equivalent (MSE) was an average of -4.69D in the LASEK group, and -4.26D in the LASIK group. At 12 months, this increased +0.026 D in the LASEK group, and -0.127D in the LASIK group, a difference that was not clinically significant.

Both best spectacle corrected visual acuity (BSCVA) and uncorrected visual acuity (UCVA) were measured several times after the procedure. In the LASIK group, the BSCVA was 20/16.3, 20/16.1 and 20/16.3 at 3, 6, and 12 months, respectively. In the LASEK group, the measures were 20/17.3, 20/17.1, and 20/17.6, respectively.

UCVA in the LASIK group was 20/19.3, 20/18.7, and 20.6 at 3, 6, and 12 months. For the LASEK group the values were 20/19.3, 20/18.3, and 20/19.3.

While BSCA was better at 1 year in the LASIK group, the difference was minor. "We were comparing 20/17.6 to 20/16.3. But 20/16.3 being the LASIK group, so, yes, statistically significant but not clinically (significant)," Dr. Fergusen told Medscape.

As for complications, the LASIK group saw 4 cases of diffuse lamellar keratitis, 2 cases had enchancement, and microstriae was evident in 1.3% of the patients. Of the microstriae, Dr. Ferguson noted that while they were evident in many patients, they were not of clinical significance.

In the LASEK group, 0.75% had visually significant haze but no other intraoperative or persistent epithelial defects.

From a soldier's perspective, Dr. Ferguson said he would choose LASEK over LASIK mainly because many consider it to have a lower risk when in situations where there is an increased risk of trauma.

"Some of the trauma occurring to the soldiers overseas are [LASIK] flaps being dislocated, you don't have that risk with LASEK.... A finger to the eye, walking into a tree, blasts from an explosive device, those could all" disrupt a flap, he said. For most people undergoing the procedure, this isn't a problem.

The study was of interest because of the impressively large numbers, said Nancy Keir, OD, a research associate at the Center for Contact Lens Research at the University of Waterloo in Ontario, Canada. She was not a part of the Warfighter study.

The researchers have shown that with both procedures there have been "excellent outcomes with the variables they measured," Dr. Keir said. Furthermore, she concurred that clinically LASEK and LASIK look similar.

ARVO 2006 Annual Meeting: Abstract B271. Presented April 30, 2006.

Reviewed by Charlotte Warren

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