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Updated: Nov 25, 2025

Author Spotlight: Advancements in Refractive Surgical Correction for Presbyopia and Exploring Postoperative Visual Acuity
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Wavefront excimer laser refractive surgery for adults with refractive errors.

Shi-Ming Li1, Meng-Tian Kang1, Ning-Li Wang1

  • 1Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Lab, Beijing Institute of Ophthalmology, Capital Medical University, Beijing, China.

The Cochrane Database of Systematic Reviews
|December 18, 2020
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Summary
This summary is machine-generated.

Wavefront refractive surgery shows no significant difference in visual outcomes compared to conventional methods. Further research is needed to clarify the benefits of wavefront-optimized versus wavefront-guided procedures.

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Area of Science:

  • Ophthalmology and Optometry
  • Surgical Innovation in Vision Correction
  • Evidence-Based Medicine in Refractive Surgery

Background:

  • Refractive errors are the leading cause of visual impairment, with myopia, hyperopia, and astigmatism commonly addressed by conventional methods.
  • Higher-order aberrations (HOAs) represent a more complex visual distortion, treatable with advanced wavefront-guided or wavefront-optimized laser surgery.
  • Wavefront techniques aim for superior visual acuity by precisely correcting refractive errors and minimizing induced HOAs.

Purpose of the Study:

  • To compare the effectiveness and safety of wavefront refractive surgery (LASIK, PRK, LASEK) against conventional procedures for correcting refractive errors.
  • To evaluate postoperative visual acuity, residual refractive errors, and residual HOAs between wavefront and conventional surgical approaches.
  • To compare the outcomes of wavefront-optimized versus wavefront-guided refractive surgery procedures.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) comparing wavefront and conventional refractive surgery techniques.
  • Searched multiple databases including Cochrane CENTRAL, MEDLINE, Embase, LILACS, ISRCTN, ClinicalTrials.gov, and WHO ICTRP up to August 2019.
  • Included RCTs involving participants aged 18 years or older with refractive errors, assessing outcomes like uncorrected visual acuity, best spectacle-corrected visual acuity, refractive targets, HOAs, and adverse events.

Main Results:

  • Limited evidence from one study suggests no significant difference between wavefront PRK and conventional PRK at 12 months for key visual outcomes (low certainty evidence).
  • Comparisons between wavefront-optimized and wavefront-guided surgery at 12 months showed no significant differences in visual acuity, refractive targets, or HOAs (low certainty evidence).
  • Wavefront-optimized LASIK may offer a slight improvement in mean spherical equivalent compared to wavefront-guided LASIK, though evidence is of low certainty.

Conclusions:

  • Current evidence indicates no substantial difference between wavefront and conventional refractive surgery, or between wavefront-optimized and wavefront-guided procedures, at 6 and 12 months postoperatively.
  • The low certainty of existing evidence suggests further RCTs are needed for more precise effect estimates, though major shifts in conclusions are unlikely.
  • Future research should consider patient-reported outcomes, such as satisfaction and the impact of residual visual aberrations, alongside clinical measures.