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    Vector planning delivers superior outcomes for myopic astigmatism

    Approach resulted in less corneal astigmatism/refractive cylinder, better unaided visual acuity


    At 3 months after surgery, there were statistically significant differences favoring the vector planning approach over conventional LASIK in analyses of percentages of eyes with manifest refraction spherical equivalent ≤ 0.13 D [(90% versus 68%; p = 0.003), ORA ≤ 0.75 D (43% versus 21%; p = 0.01), and corneal astigmatism < 0.75 D (75% versus 34%; p < 0.0001)].

    Compared with conventional LASIK, the vector planning group had higher values for arithmetic mean refractive cylinder (0.10 D versus 0.08 D), but lower values for arithmetic mean corneal astigmatism (0.65 D versus 1.11 D) and arithmetic mean ORA (0.71 D versus 1.06 D).

    The percentage of eyes achieving uncorrected distance visual acuity of 20/20 or better was also higher with vector planning compared with the conventional treatment group (96% versus 93%), although the difference was not statistically significant.

    “When it comes to corneal astigmatism, less is more because corneal astigmatism affects visual outcomes,” he said. “Surgeons should evaluate the ORA preoperatively and recognize that eyes with high ORA, >1 D, are at high risk for a potential adverse result due to undercorrected corneal astigmatism or in some cases, increased corneal astigmatism postoperatively.”

    More widespread adoption of a vector planning approach could increase patient uptake of LASIK by improving outcomes, he noted.

    Authors of a literature review published in 2009 reported that 95.4% of patients were happy with their visual outcomes after LASIK [Solomon KD, et al. Ophthalmology. 2009;116:691-701].

    “While that is a high satisfaction rate, the flipside is that 4.6% of patients were ambivalent or unhappy with their outcomes,” Dr. Alpins said. “This might be magnified by a factor of 9 when considering the collateral effect of these unhappy people and help to explain the flat-lined interest in LASIK in recent years.”

    He added that vector planning has the potential to reduce the rate of patient dissatisfaction to 1% so that the demand for the procedure might flourish.


    Noel Alpins, MD

    E: [email protected]

    This article was adapted from Dr. Alpins’ presentation at the 2017 meeting of the American Society of Cataract and Refractive Surgery. For more information on this topic, readers may refer to Dr. Alpins’ new book, Practical Astigmatism-Planning and Analysis, which will be published in September 2017. Dr. Alpins is the chief executive officer and has a financial interest in ASSORT Surgical Management Systems used for vector planning treatments and astigmatism analyses.

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