Factors Affecting Ray Trace LASIK Data Acquisition in Clinical Practice: Options for Addressing Accommodation

To assess factors affecting successful data acquisition for InnovEyes guided ray trace LASIK.

Single-site ophthalmology practice.

Retrospective review.

A total of 1283 eyes with myopia and myopic astigmatism were assessed over 18-months for ray trace-based LASIK planning. Preoperative measurements were acquired using the InnovEyes Sightmap (Wavelight Plus, Alcon). Scan time per eye, number of scans, pupil size, calculated refraction and manifest spherical equivalent (SEQ) refraction were assessed. In a subset of eyes with significant accommodation, aberrometry-based refraction was adjusted prior to treatment, or cycloplegic measurement was used for treatment planning. In these subsets, 3-month post-operative refractive outcomes were analysed.

Mean noncycloplegic scanning time (11.10±14.11 minutes/eye to 8.10±3.17 minutes/eye) and number of noncycloplegic scans per eye (6.28±2.97 scans to 5.23±2.12 scans) decreased over time. In nine eyes where the wavefront SEQ (4 mm) was less myopic (by 0.5D or more) than the manifest SEQ and no adjustment was made, all achieved uncorrected distance visual acuity (UDVA) of 20/20 or better. In 274 eyes (21.4%), wavefront SEQ (4mm) was more myopic (by > 0.5D) than manifest SEQ. Surgeon adjusted treatment in 95 eyes to within 0.5D of manifest SEQ resulted in 98% achieving UDVA of 20/20 or greater. In 23 eyes treated using cycloplegic wavefront data, 96% achieved UDVA of 20/20 or greater.

Use of the InnovEyes Sightmap system for ray trace LASIK is feasible in a clinical environment but demonstrates an operator learning curve. Accommodation during wavefront measurement can occur; this can be managed through surgeon adjustment of treatment or the use of cycloplegic wavefront data.