Outcomes of Hyperopic LASIK With the NIDEK NAVEX Platform Centered on the Visual Axis or Line of Sight

Abstract

Purpose: To report refractive outcomes of hyperopic LASIK with automated centration on the visual axis compared with centration on the line of sight (LOS). Methods: The NIDEK Advanced Vision Excimer Laser platform (NAVEX) was used to treat 181 hyperopic eyes with centration on the LOS (LOS group) and 64 hyperopic eyes with centration on the visual axis (visual axis group). The coordinates of the visual axis were digitally transferred to the excimer laser system based on the positional relationship between the LOS and the coaxially sighted corneal light reflex. All eyes were treated with a 6.5-mm optical zone and 9.0-mm transition zone. Three-month postoperative outcomes were retrospectively analyzed. Results: The preoperative manifest refraction spherical equivalent (MRSE) was +2.57±1.26 diopters (D) (range: 0.13 to 5.63 D) in the visual axis group and +2.46±1.32 D (range: 0.38 to 5.63 D) in the LOS group. The postoperative MRSE was +0.29±0.70 D (range: −1.00 to 1.75 D) in the visual axis group and +0.19±0.57 D (range: −0.75 to 1.75 D) in the LOS group. Postoperatively, 81% (38/47) of eyes in the visual axis group and 64% (74/116) of eyes in the LOS group were ±0.50 D. In the visual axis group, 91% (44/52) of eyes and 92% (102/109) of eyes in the LOS group maintained best spectacle-corrected visual acuity within one line compared with preoperatively. Conclusions: Initial experience with hyperopic LASIK centered on the visual axis indicated safe and predictable outcomes. [ J Refract Surg . 2009;25:S98–S103.]

Comparison of Myopic LASIK Centered on the Coaxially Sighted Corneal Light Reflex or Line of Sight

“…The majority of eyes were within 0.50 D of the intended MRSE. Similar to Kermani et al, 2 the outcomes presented here represent Visual Axis vs Line of Sight/Okamoto et al our initial experience of centering towards the CSCLR (P-Dist 80%) in a controlled, predictable, and repeatable manner rather than subjective surgeon-sighting. This study was spurred by our personal experience, in which centering the ablation on the pupil resulted in a small percentage of decentered ablations postoperatively (data not shown) despite our subjective impression that we achieved excellent ablation centration intraoperatively.…”

Comparison of Myopic LASIK Centered on the Coaxially Sighted Corneal Light Reflex or Line of Sight

“…The majority of eyes were within 0.50 D of the intended MRSE. Similar to Kermani et al, 2 the outcomes presented here represent Visual Axis vs Line of Sight/Okamoto et al our initial experience of centering towards the CSCLR (P-Dist 80%) in a controlled, predictable, and repeatable manner rather than subjective surgeon-sighting. This study was spurred by our personal experience, in which centering the ablation on the pupil resulted in a small percentage of decentered ablations postoperatively (data not shown) despite our subjective impression that we achieved excellent ablation centration intraoperatively.…”

Coaxially Sighted Corneal Light Reflex Versus Entrance Pupil Center Centration of Moderate to High Hyperopic Corneal Ablations in Eyes With Small and Large Angle Kappa

“…Finally, the results of the current study may only apply to hyperopic treatments using the MEL80 ex-CSCLR vs Pupil Center Centration/Reinstein et al cimer laser due to differences in ablation profi le design, although similar results have been reported using other excimer laser systems where the treatment has been centered on the CSCLR or corneal vertex. 11,[13][14][15] The current study found similar refractive outcomes visual quality and subjective night vision between a group of eyes with a small angle kappa and a group of eyes with a large angle kappa after moderate to high hyperopic LASIK where the ablation was centered on the CSCLR. This provides evidence to support the hypothesis that ablations should be centered on the visual axis (or closest approximation).…”

Clinical outcomes of corneal refractive surgery comparing centration on the corneal vertex with the pupil center: a meta-analysis

“…There were seven articles describing a total of 1964 eyes included in this meta-analysis after assessment of the complete manuscripts. Of seven publications, five described myopic correction [13][14][15][16][17] and two described hyperopic correction [18,19]. Four studies claimed to have used randomized methods [13,16,17,19], and three of them applied a double-masked approach [16,17,19].…”

“…Wu et al explained that the corneal optical center (COC) used in their study was regarded as similar to the corneal light reflex [14]. Conservative approaches of alignment closing to the CSCLR were performed in two studies, either as 80% of the distance of the photopic pupil center and the CSCLR (80% P-Dist) [15], or 50% of the distance of the photopic pupil center and the CSCLR (50% P-Dist) [18]. All included studies used the eye tracker system rather than subjective centration on the pupil center except for Wu et al All the included studies were performed with LASIK procedure.…”

“…2). The results revealed a large heterogeneity when myopic and hyperopic corrections were combined together (I 2 = 51%); thus, subgroup analyses were performed by dividing the data into the myopic group [13][14][15][16][17] and the hyperopic group [18,19] according to the original statements of included studies. For the correction of myopia, a significant difference in favor of CV-centered method in postoperative SE was found between the two centration methods in the fixed-effects model (WMD: -0.08, 95% CI [-0.12, -0.04], Z = 4.24, p \ 0.001).…”

Comparison of Myopic LASIK Centered on the Coaxially Sighted Corneal Light Reflex or Line of Sight

“…The majority of eyes were within 0.50 D of the intended MRSE. Similar to Kermani et al, 2 the outcomes presented here represent Visual Axis vs Line of Sight/Okamoto et al our initial experience of centering towards the CSCLR (P-Dist 80%) in a controlled, predictable, and repeatable manner rather than subjective surgeon-sighting. This study was spurred by our personal experience, in which centering the ablation on the pupil resulted in a small percentage of decentered ablations postoperatively (data not shown) despite our subjective impression that we achieved excellent ablation centration intraoperatively.…”

Coaxially Sighted Corneal Light Reflex Versus Entrance Pupil Center Centration of Moderate to High Hyperopic Corneal Ablations in Eyes With Small and Large Angle Kappa

“…Finally, the results of the current study may only apply to hyperopic treatments using the MEL80 ex-CSCLR vs Pupil Center Centration/Reinstein et al cimer laser due to differences in ablation profi le design, although similar results have been reported using other excimer laser systems where the treatment has been centered on the CSCLR or corneal vertex. 11,[13][14][15] The current study found similar refractive outcomes visual quality and subjective night vision between a group of eyes with a small angle kappa and a group of eyes with a large angle kappa after moderate to high hyperopic LASIK where the ablation was centered on the CSCLR. This provides evidence to support the hypothesis that ablations should be centered on the visual axis (or closest approximation).…”

Clinical outcomes of corneal refractive surgery comparing centration on the corneal vertex with the pupil center: a meta-analysis

“…There were seven articles describing a total of 1964 eyes included in this meta-analysis after assessment of the complete manuscripts. Of seven publications, five described myopic correction [13][14][15][16][17] and two described hyperopic correction [18,19]. Four studies claimed to have used randomized methods [13,16,17,19], and three of them applied a double-masked approach [16,17,19].…”

“…Wu et al explained that the corneal optical center (COC) used in their study was regarded as similar to the corneal light reflex [14]. Conservative approaches of alignment closing to the CSCLR were performed in two studies, either as 80% of the distance of the photopic pupil center and the CSCLR (80% P-Dist) [15], or 50% of the distance of the photopic pupil center and the CSCLR (50% P-Dist) [18]. All included studies used the eye tracker system rather than subjective centration on the pupil center except for Wu et al All the included studies were performed with LASIK procedure.…”

“…2). The results revealed a large heterogeneity when myopic and hyperopic corrections were combined together (I 2 = 51%); thus, subgroup analyses were performed by dividing the data into the myopic group [13][14][15][16][17] and the hyperopic group [18,19] according to the original statements of included studies. For the correction of myopia, a significant difference in favor of CV-centered method in postoperative SE was found between the two centration methods in the fixed-effects model (WMD: -0.08, 95% CI [-0.12, -0.04], Z = 4.24, p \ 0.001).…”

Comparison of Myopic LASIK Centered on the Coaxially Sighted Corneal Light Reflex or Line of Sight

“…The majority of eyes were within 0.50 D of the intended MRSE. Similar to Kermani et al, 2 the outcomes presented here represent Visual Axis vs Line of Sight/Okamoto et al our initial experience of centering towards the CSCLR (P-Dist 80%) in a controlled, predictable, and repeatable manner rather than subjective surgeon-sighting. This study was spurred by our personal experience, in which centering the ablation on the pupil resulted in a small percentage of decentered ablations postoperatively (data not shown) despite our subjective impression that we achieved excellent ablation centration intraoperatively.…”

Coaxially Sighted Corneal Light Reflex Versus Entrance Pupil Center Centration of Moderate to High Hyperopic Corneal Ablations in Eyes With Small and Large Angle Kappa

“…Finally, the results of the current study may only apply to hyperopic treatments using the MEL80 ex-CSCLR vs Pupil Center Centration/Reinstein et al cimer laser due to differences in ablation profi le design, although similar results have been reported using other excimer laser systems where the treatment has been centered on the CSCLR or corneal vertex. 11,[13][14][15] The current study found similar refractive outcomes visual quality and subjective night vision between a group of eyes with a small angle kappa and a group of eyes with a large angle kappa after moderate to high hyperopic LASIK where the ablation was centered on the CSCLR. This provides evidence to support the hypothesis that ablations should be centered on the visual axis (or closest approximation).…”

Clinical outcomes of corneal refractive surgery comparing centration on the corneal vertex with the pupil center: a meta-analysis

“…There were seven articles describing a total of 1964 eyes included in this meta-analysis after assessment of the complete manuscripts. Of seven publications, five described myopic correction [13][14][15][16][17] and two described hyperopic correction [18,19]. Four studies claimed to have used randomized methods [13,16,17,19], and three of them applied a double-masked approach [16,17,19].…”

“…Wu et al explained that the corneal optical center (COC) used in their study was regarded as similar to the corneal light reflex [14]. Conservative approaches of alignment closing to the CSCLR were performed in two studies, either as 80% of the distance of the photopic pupil center and the CSCLR (80% P-Dist) [15], or 50% of the distance of the photopic pupil center and the CSCLR (50% P-Dist) [18]. All included studies used the eye tracker system rather than subjective centration on the pupil center except for Wu et al All the included studies were performed with LASIK procedure.…”

“…2). The results revealed a large heterogeneity when myopic and hyperopic corrections were combined together (I 2 = 51%); thus, subgroup analyses were performed by dividing the data into the myopic group [13][14][15][16][17] and the hyperopic group [18,19] according to the original statements of included studies. For the correction of myopia, a significant difference in favor of CV-centered method in postoperative SE was found between the two centration methods in the fixed-effects model (WMD: -0.08, 95% CI [-0.12, -0.04], Z = 4.24, p \ 0.001).…”