What is the difference between Wavefront Optimised vs Wavefront Guided LASIK?

Doctor's Answers 1

To answer this question, we need to start from basics.

What is a wavefront? According to Wikipedia: In physics, a wavefront is the 'locus of points characterized by propagation of positions of identical phase'.

If you throw a stone into a pool of water, you will see ripples spreading out, and each ripple can be considered a 'wavefront'. This effect can be applied to all kinds of waves, including light waves.

With regard to optics and eyesight, a good image is captured (by a sensor such as film, a chip, the retina) when a wavefront of light entering the camera/eye is focused as perfectly as possible ie with as few wavefront 'aberrations'/irregularities as possible. Wavefront aberrations can be

1. Low order (such as shortsight/longsight/astigmatism) or

2. High order (such as spherical aberration, coma, trefoil, etc)

Refractive surgeries such as LASIK can induce high order aberrations. Older generations of LASIK machines tended to induce spherical aberrations, so measures were instituted to reduce this. 'Wavefront Optimised' is a term used by Wavelight/Alcon systems to denote laser algorithms/programs where the induction of spherical aberration is minimised. It is still a 'standard' treatment, ie it does not attempt to smoothen out any pre-existing irregularities in a particular patient.

All of our eyes have pre-existing tiny imperfections in focusing that are already causing certain amounts of wavefront aberrations naturally. These are unique to the particular individual.

So 'Wavefront Guided' treatments attempt to correct our naturally pre-existing wavefront aberrations, and can be considered customised treatments.

To recap, 'Wavefront Optimized' treatments are 'standard' treatments, which make no attempt to correct pre-existing aberrations in a particular eye.

'Wavefront Guided' treatments are 'customized' treatments, which attempt to correct pre-existing aberrations in a particular eye.

It is not quite accurate to issue a blanket statement to say that one or the other treatment is better.

In my practice, I sometimes perform 'Wavefront Optimised' and sometimes 'Wavefront Guided' treatments. For example, some eyes naturally have few aberrations. With some other eyes it is not possible to get good wavefront measurements. These eyes would do better with Wavefront Optimised treatments. The other kinds of eyes may benefit from Wavefront Guided treatments, which would potentially give better, sharper vision especially at night when compared to the Wavefront Optimised treatments.

Why not do 'Wavefront Guided' treatments for everybody, you might ask? There are many possible reasons, including Wavefront Guided treatments using slightly more corneal tissue, and the fact that using an inaccurate wavefront measurement can cause a wrong treatment and induce even more aberrations.

Perhaps you may see now that the issue is a bit more complicated than it first seems.

It is probably more important that you consult with an experienced surgeon, who can offer various methods of treatment and customize an approach that is best for your particular situation.

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How can I prevent blood clots on the whites of my eyes after LASIK?

Hi Susanne In the first step of the LASIK procedure, a ‘flap’ is created using a femtosecond laser (or, in the past, a special blade called a microkeratome). During this step, the laser is ‘connected’/docked to the eye with a ring-like device that grips the white part of your eye. You can watch an animation here: There are many small blood vessels on this part of the eye, and sometimes the suction pressure providing the grip may cause some of the blood vessels to leak some blood, causing red patches after the LASIK.

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What factors should I consider in deciding whether Punctal Plugs are the right treatment for my dry eyes after LASIK?

Punctal plugs are very effective for treating dry eyes that occur during waking hours, whether or not the situation is associated with LASIK. They help to reduce the need for eyedrops, so are very useful for people who have to use artificial tears very frequently eg instead of having to use the eyedrops every 2-3 hourly, sometimes after the plugs are placed, the eyedrops might only be needed every 4-6 hourly. As long as there is no active eye inflammation (eg persistent eye redness/discharge), punctal plugs can help anyone with moderate dry eyes requiring frequent eyedrop instillation.

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