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May 1998

Should Laser Refractive Surgery Be Delayed? There Is No Benefit to Deferring Laser Refractive Surgery

Arch Ophthalmol. 1998;116(5):669-672. doi:10.1001/archopht.116.5.669

HOW SAFE is laser refractive surgery? Five (1.2%) of 398 eyes lost 2 or more lines of best-corrected visual acuity at 1 year in the Summit study; the similar percentage for the VisX study was 11 (2.2%) of 520 eyes. Some have argued that best spectacle-corrected visual acuity is an inadequate measure of visual performance and have suggested that contrast sensitivity or low contrast acuity are better measures of the impact of laser refractive surgery on visual performance. Photorefractive keratectomy has minimal effect on contrast sensitivity.1 On the other hand, of some concern is the mean loss of 1.5 lines of best spectacle–corrected low contrast undilated visual acuity in eyes undergoing PRK with a 5-mm optical zone.1 In patients treated in 1996 with a 6-mm optical zone, however, the mean loss was 0.5 lines (unpublished data, Michael Olson, OD, PhD, Mark Bullimore, OD, PhD, and R.K.M., 1998). Corneal haze is now rare; of the 398 eyes treated in the Summit study, none had corneal haze of moderate or marked degree at 1 year after PRK. In the VisX study, only 0.06% of eyes had similar haze. Haze is more common in patients with higher myopia, but laser in situ keratomileusis (LASIK) appears to be an excellent alternative treatment for these patients. Laser in situ keratomileusis eliminates the risk of corneal haze, although it does introduce the risk of flap complications. With an experienced surgeon, flap complications are sufficiently rare that LASIK is probably the treatment of choice for patients with higher myopia and might be the treatment of choice for all myopic patients.2-5