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Visual Outcomes and Safety of Ray-Tracing-Guided Laser-Assisted In Situ Keratomileusis: A Systematic Review and
Maximilian Friedrich1, Victor A Augustin1, Gerd U Auffarth1
1David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
Topic:
The aim of this analysis was to evaluate the visual outcome and safety profile after ray-tracing-guided laser-assisted in situ keratomileusis (RTG-LASIK) for myopia with or without astigmatism.
Clinical Relevance:
RTG-LASIK is a modern approach in refractive surgery using only objective and automated measurements aiming to improve visual outcomes.
Methods:
In this systematic literature review and meta-analysis (International Prospective Register of Systematic Reviews [PROSPERO] ID: CRD420251179631), original peer-reviewed clinical studies on the visual outcomes of RTG-LASIK in eyes with myopia ± astigmatism were included. Exclusion criteria were corneal ectasia or other ocular comorbidities, hyperopia, and ablation profile modification by the surgeon. Cochrane, Embase, PubMed, and Web of Science databases were screened on 31 October 2025. The risk of bias was assessed using the Risk of Bias in Non-Randomized Studies-of Interventions tool. Primary effect measures were the proportions of eyes achieving 20/20 uncorrected distance visual acuity (UDVA) and losing ≥ 1 line of corrected distance visual acuity (CDVA) after RTG-LASIK. Secondary outcomes included the distribution of eyes regarding preoperative CDVA and postoperative UDVA, changes in Snellen lines for CDVA and UDVA relative to preoperative CDVA, postoperative manifest refraction spherical equivalent (MRSE), higher-order aberrations (HOAs), and other refractive parameters, synthesized using a random-effects model. In addition, postoperative complications were documented.
Results:
In total, 14 clinical studies with a total of 1577 eyes were included in the meta-analysis. The pooled percentage of eyes with postoperative UDVA ≥ 20/20 was 99.17% (95% confidence interval [CI]: 95.75%, 99.84%; I2 = 47.4%; 14 studies; n = 1577). Loss of ≥ 1 line in CDVA after RTG-LASIK occurred in 2.21% (95% CI: 1.07%, 4.52%; I2 = 38.5%; 11 studies; n = 1384). CDVA showed an improvement in nearly half of all cases. In addition, postoperative UDVA tended to improve compared with preoperative CDVA. MRSE was within 0.5 D of target refraction in 95.21% but showed a slight trend toward overcorrection. Total HOAs increased slightly by 0.087 µm (95% CI: 0.027, 0.148; I2 = 97.5%; 8 studies; n = 1189), while spherical aberration and trefoil tended to decrease after RTG-LASIK. The studies reported nine refractive retreatments and a generally favorable complication profile.
Discussion:
This meta-analysis suggests that RTG-LASIK may be a safe and effective procedure for improving UDVA and CDVA in selected myopic eyes in the short term, with relatively low reported complication rates. However, larger prospective studies with longer follow-up are needed to confirm these findings and better define long-term safety and efficacy.
Trial Registration:
This systematic review and meta-analysis has been prospectively registered at PROSPERO (PROSPERO ID: CRD420251179631).
