Influence of Refractive Error, Age, and Ophthalmic Anatomical Characteristics on Refractive Surgery Choices

To assess the characteristics of patients presenting to American-European Congress of Ophthalmic Surgery (AECOS) member practices for vision correction procedures and determine how age, refractive error, and ophthalmic anatomical characteristics determine the choice of refractive procedure.

This retrospective multicenter cohort study included data of myopic patients who underwent bilateral refractive surgery in 2023 at 18 refractive surgery practices. Study parameters included the procedure performed, surgical location, manifest refraction (MRSE), Pentacam D value, anterior chamber depth, and central pachymetry.

Overall, 1,866 eyes of 933 patients were included. LASIK was the most common refractive surgery procedure (65.5%), followed by ICL (13.3%), PRK (12.1%), and KLEx (8.6%). Of all the procedures, 59.4% were performed in a laser suite, 26.3% in an in-office operating room (OR), 13.8% in an ambulatory surgery center (ASC), and 0.5% in a hospital OR. The mean MRSE was -4.36 D. Among laser vision correction procedures (LASIK, PRK, and KLEx), 43.6% had low myopia (MRSE range: -0.25 to -3.00 D), 43.1% had moderate (-3.01 to -6.00 D), and 13.3% had high myopia (>6.00 D). Among all ICL cases, 3.6%, 21.0%, and 75.4% were performed in low, moderate, and high myopes, respectively. Among eyes that underwent LASIK or KLEx, 2.8% had thinner corneas (central pachymetry <500 µm), which was significantly lower than 12.4% of eyes undergoing PRK (p<0.001) and 11.7% of those undergoing ICL surgery (p<0.001).

The study's findings help to understand and better define the refractive surgery choices made by patients and surgeons. LASIK contributed to almost two-thirds of the refractive surgery procedures.