With-the-Rule (WR) Vs. Against-the-Rule (AR) Vs. Oblique Cylinder (OC): Which Do Better after LASIK Using the Clinical Refraction, and How? | ASCRS
Presentation
With-the-Rule (WR) Vs. Against-the-Rule (AR) Vs. Oblique Cylinder (OC): Which Do Better after LASIK Using the Clinical Refraction, and How?
May 2020
Meeting: 2020 Virtual Annual Meeting
Session: SPS-115 Refractive Procedure Comparisons: PRK, LASIK
Authors: Costas H. Karabatsas, MD, PhD, A. John Kanellopoulos MD
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Purpose
Comparison of different types of cylindrical orientation in myopic LASIK

Methods
200 myopic wavefront optimised LASIK cases were retrospectively evaluated for: UDVA, CDVA, Refractive error (RE), topography, tomography. Use of pre-op data available were used to also generate virtual topography-guided LASIK (tgL) plan with topography-modified refraction (TMR) for the cylinder amount and axis adjustment, and correlated to the actual residual refractive and topographic data available. Comparison between the 3 groups was made.

Results
In consecutive myopic LASIK the relative distribution of naïve astigmatism was: WR:171 (85.5%), AR: 10 (0.5%), OC: 19 (0.95%). Overall post-LASIK data for all 3 groups: UDVA: 20/22, CDVA 20/20, RE in Diopters: -0.35 sphere and -0.75 Cylinder. Breakdown for each group was: Residual refractive error of over -0.25 Diopters: WR: 76%, OC: 15%, AR: 9%. When speculating the use of TMR at that time: It would have reduced the residual refractive cylinder in WR more than the AR and then more than the OC group, that appeared to perform best in this regard with WFO LASIK and the clinical refraction used at the time.

Conclusion
Standard Clinical refraction used in WFO LASIK may result in residual refractive cylinder more in with-the-rule candidates. Using TMR and topography-guided LASIK instead may offer improved outcomes through accurate cylinder correction.
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This presentation is from the session "SPS-115 Refractive Procedure Comparisons: PRK, LASIK" from the 2020 ASCRS Virtual Annual Meeting held on May 16-17, 2020.

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