Key Takeaways

  • Raytracing-guided LASIK reduced higher-order aberrations approximately 70% in 55 pseudophakic eyes

  • Visual acuity, residual astigmatism, and mesopic contrast sensitivity improved at 3 months.

Raytracing-guided LASIK enhancement using Alcon's Wavelight Plus diagnostic and treatment platform significantly reduced higher-order aberrations and improved visual acuity in patients with residual visual complaints following cataract surgery, according to research presented at the 130th annual meeting of the American Academy of Ophthalmology (AAO).

The study, led by A. John Kanellopoulos, MD, evaluated 55 pseudophakic eyes implanted with monofocal toric, extended depth-of-focus, or trifocal IOLs. All eyes underwent raytracing-guided LASIK enhancement using the WaveLight Plus.

At 3 months, mean uncorrected distance visual acuity improved from 20/23 to 20/16, while best-corrected visual acuity improved from 20/16 to 20/12. Residual astigmatism decreased from −0.85 D to −0.25 D. Higher-order aberrations declined approximately 70%, from 1.55 μm preoperatively to 0.45 μm postoperatively. Mesopic contrast sensitivity also improved by 1 to 7 steps across spatial frequencies.

"We are seeing a growing group of patients who have had technically excellent cataract surgery, often with premium implants, and who are nevertheless unhappy with their vision," said A. John Kanellopoulos, MD, who led the research. Many, he said, have "optical complaints that do not show up on a standard eye chart at all."

According to the investigators, subtle IOL tilt or decentration relative to the cornea and visual axis may contribute to optical aberrations that conventional refractive measurements do not adequately capture. Unlike traditional corneal topography—or wavefront-guided treatments, raytracing models the eye's complete optical system to calculate a customized laser correction.

The researchers noted that using the platform in pseudophakic eyes is off-label, as the technology was developed and approved for eyes without prior surgery.

Dr. Kanellopoulos suggested that raytracing-guided enhancement could provide a less invasive alternative to IOL exchange in appropriately selected patients.

Investigators plan additional prospective research comparing raytracing-guided treatment with conventional laser enhancement and evaluating longer-term outcomes and patient-reported visual quality.