Comparison of optical quality parameters and ocular aberrations after wavefront-guided laser in-situ keratomileusis versus wavefront-guided laser epithelial keratomileusis for myopia

  • Kwanghyun Lee
  • Ji Min Ahn
  • Eung Kweon Kim
  • Tae-im KimEmail author
Refractive Surgery



To compare optical quality, ocular scattering, and higher-order aberrations (HOAs) after laser in-situ keratomileusis (LASIK) versus laser epithelial keratomileusis (LASEK).


A total of 47 eyes from 47 participants who had undergone LASIK (group I) or LASEK (group II) procedure at least 6 months prior were enrolled. Ocular aberrations and modulation transfer function (MTF) values measured using iTrace, a ray-tracing type aberrometer, were compared to MTF (modulation transfer function) cut-off values, Strehl ratio, and objective indices of scattering obtained using the Objective Quality Analysis System II (OQAS II).


There was no significant correlation between the postoperative optical quality parameters and the HOAs between both groups. In group I, the MTF cut-off value was significantly correlated with cylinder refraction (p = 0.037), and the objective scattering index (OSI) was positively correlated with spherical equivalent (p = 0.023). In group II, there was a statistically significant correlation between the OSI and achieved refractive correction (p = 0.001). Regression analysis showed that the OSI was the most significant predictor of MTF cut-off values after refractive surgery. Additionally, MTF values measured by OQAS were significantly lower than those measured by iTrace without correlation.


Optical quality after refractive surgery may be influenced by not only ocular aberrations but also by scattering. Even though the accuracies of the machines used in this study to measure optical quality have yet to be proven, this study showed limited correlation among the values measured using the two different machines after refractive surgery. Therefore, for more generalized evaluation of visual function after refractive surgery, more advanced optical devices still need to be developed.


Optical quality Higher order aberrations Ocular scattering Refractive surgery 



We would like to acknowledge Yura Shin from Hankuk Academy of Foreign Studies for her help with analysis of the clinical data and the correction of English in the study. This study was supported by grant MEST (supported in part by grant MEST 2010-0022006) from the National Research Foundation of Korea and the Converging Research Center Program funded by the Ministry of Education, Science and Technology (2012K001354).




  1. 1.
    Esquenazi S, He J, Bazan NG, Bazan HE (2005) Comparison of corneal wound-healing response in photorefractive keratectomy and laser-assisted subepithelial keratectomy. J Cataract Refract Surg 31:1632–1639PubMedCrossRefGoogle Scholar
  2. 2.
    Munnerlyn CR, Koons SJ, Marshall J (1988) Photorefractive keratectomy: A technique for laser refractive surgery. J Cataract Refract Surg 14:46–52PubMedCrossRefGoogle Scholar
  3. 3.
    Saleh TA, Almasri MA (2003) A comparative study of post-operative pain in laser epithelial keratomileusis versus photorefractive keratectomy. Surgeon 1:229–232PubMedCrossRefGoogle Scholar
  4. 4.
    Sugar A, Rapuano CJ, Culbertson WW, Huang D, Varley GA, Agapitos PJ, de Luise VP, Koch DD (2002) Laser in situ keratomileusis for myopia and astigmatism: safety and efficacy: A report by the American Academy of Ophthalmology. Ophthalmology 109:175–187PubMedCrossRefGoogle Scholar
  5. 5.
    Applegate RA, Marsack JD, Ramos R, Sarver EJ (2003) Interaction between aberrations to improve or reduce visual performance. J Cataract Refract Surg 29:1487–1495PubMedCrossRefGoogle Scholar
  6. 6.
    van de Pol C, Soya K, Hwang DG (2001) Objective assessment of transient corneal haze and its relation to visual performance after photorefractive keratectomy. Am J Ophthalmol 132:204–210PubMedCrossRefGoogle Scholar
  7. 7.
    Montes-Mico R, Cervino A, Ferrer-Blasco T, Garcia-Lazaro S, Madrid-Costa D (2010) The tear film and the optical quality of the eye. Ocul Surf 8:185–192PubMedCrossRefGoogle Scholar
  8. 8.
    Sharma M, Wachler BS, Chan CC (2007) Higher order aberrations and relative risk of symptoms after LASIK. J Refract Surg 23:252–256PubMedGoogle Scholar
  9. 9.
    Yamane N, Miyata K, Samejima T, Hiraoka T, Kiuchi T, Okamoto F, Hirohara Y, Mihashi T, Oshika T (2004) Ocular higher-order aberrations and contrast sensitivity after conventional laser in situ keratomileusis. Invest Ophthalmol Vis Sci 45:3986–3990PubMedCrossRefGoogle Scholar
  10. 10.
    Buzzonetti L, Iarossi G, Valente P, Volpi M, Petrocelli G, Scullica L (2004) Comparison of wavefront aberration changes in the anterior corneal surface after laser-assisted subepithelial keratectomy and laser in situ keratomileusis: preliminary study. J Cataract Refract Surg 30:1929–1933PubMedCrossRefGoogle Scholar
  11. 11.
    Chalita MR, Xu M, Krueger RR (2003) Correlation of aberrations with visual symptoms using wavefront analysis in eyes after laser in situ keratomileusis. J Refract Surg 19:S682–686PubMedGoogle Scholar
  12. 12.
    Prieto PM, Vargas-Martin F, Goelz S, Artal P (2000) Analysis of the performance of the Hartmann-Shack sensor in the human eye. J Opt Soc Am A Opt Image Sci Vis 17:1388–1398PubMedCrossRefGoogle Scholar
  13. 13.
    Moreno-Barriuso E, Navarro R (2000) Laser ray tracing versus Hartmann–Shack sensor for measuring optical aberrations in the human eye. J Opt Soc Am A Opt Image Sci Vis 17:974–985PubMedCrossRefGoogle Scholar
  14. 14.
    Thibos LN (2000) Principles of Hartmann–Shack aberrometry. J Refract Surg 16:S563–565PubMedGoogle Scholar
  15. 15.
    Molebny VV, Panagopoulou SI, Molebny SV, Wakil YS, Pallikaris IG (2000) Principles of ray tracing aberrometry. J Refract Surg 16:S572–575PubMedGoogle Scholar
  16. 16.
    Artal P, Marcos S, Navarro R, Williams DR (1995) Odd aberrations and double-pass measurements of retinal image quality. J Opt Soc Am A Opt Image Sci Vis 12:195–201PubMedCrossRefGoogle Scholar
  17. 17.
    Ondategui JC, Vilaseca M, Arjona M, Montasell A, Cardona G, Guell JL, Pujol J (2012) Optical quality after myopic photorefractive keratectomy and laser in situ keratomileusis: comparison using a double-pass system. J Cataract Refract Surg 38:16–27PubMedCrossRefGoogle Scholar
  18. 18.
    Pallikaris IG, Kymionis GD, Panagopoulou SI, Siganos CS, Theodorakis MA, Pallikaris AI (2002) Induced optical aberrations following formation of a laser in situ keratomileusis flap. J Cataract Refract Surg 28:1737–1741PubMedCrossRefGoogle Scholar
  19. 19.
    Waheed S, Chalita MR, Xu M, Krueger RR (2005) Flap-induced and laser-induced ocular aberrations in a two-step LASIK procedure. J Refract Surg 21:346–352PubMedGoogle Scholar
  20. 20.
    Ivarsen A, Laurberg T, Moller-Pedersen T (2004) Role of keratocyte loss on corneal wound repair after LASIK. Invest Ophthalmol Vis Sci 45:3499–3506PubMedCrossRefGoogle Scholar
  21. 21.
    Lapid-Gortzak R, van der Linden JW, van der Meulen I, Nieuwendaal C, van den Berg T (2010) Straylight measurements in laser in situ keratomileusis and laser-assisted subepithelial keratectomy for myopia. J Cataract Refract Surg 36:465–471PubMedCrossRefGoogle Scholar
  22. 22.
    Nochez Y, Majzoub S, Pisella PJ (2011) Effect of residual ocular spherical aberration on objective and subjective quality of vision in pseudophakic eyes. J Cataract Refract Surg 37:1076–1081PubMedCrossRefGoogle Scholar
  23. 23.
    Nochez Y, Majzoub S, Pisella PJ (2012) Effect of interaction of macroaberrations and scattered light on objective quality of vision in pseudophakic eyes with aspheric monofocal intraocular lenses. J Cataract Refract Surg 38:633–640PubMedCrossRefGoogle Scholar
  24. 24.
    Lapid-Gortzak R, van der Linden JW, van der Meulen IJ, Nieuwendaal CP, Mourits MP, van den Berg TJ (2010) Straylight before and after hyperopic laser in situ keratomileusis or laser-assisted subepithelial keratectomy. J Cataract Refract Surg 36:1919–1924PubMedCrossRefGoogle Scholar
  25. 25.
    Moller-Pedersen T, Cavanagh HD, Petroll WM, Jester JV (1998) Corneal haze development after PRK is regulated by volume of stromal tissue removal. Cornea 17:627–639PubMedCrossRefGoogle Scholar
  26. 26.
    Nieto-Bona A, Lorente-Velazquez A, Collar CV, Nieto-Bona P, Mesa AG (2010) Intraocular straylight and corneal morphology six months after LASIK. Curr Eye Res 35:212–219PubMedCrossRefGoogle Scholar
  27. 27.
    Sarayba MA, Ignacio TS, Binder PS, Tran DB (2007) Comparative study of stromal bed quality by using mechanical, IntraLase femtosecond laser 15- and 30-kHz microkeratomes. Cornea 26:446–451PubMedCrossRefGoogle Scholar
  28. 28.
    Medeiros FW, Stapleton WM, Hammel J, Krueger RR, Netto MV, Wilson SE (2007) Wavefront analysis comparison of LASIK outcomes with the femtosecond laser and mechanical microkeratomes. J Refract Surg 23:880–887PubMedGoogle Scholar
  29. 29.
    Bamba S, Rocha KM, Ramos-Esteban JC, Krueger RR (2009) Incidence of rainbow glare after laser in situ keratomileusis flap creation with a 60 kHz femtosecond laser. J Cataract Refract Surg 35:1082–1086PubMedCrossRefGoogle Scholar
  30. 30.
    Artal P, Benito A, Perez GM, Alcon E, De Casas A, Pujol J, Marin JM (2011) An objective scatter index based on double-pass retinal images of a point source to classify cataracts. PLoS One 6:e16823PubMedCrossRefGoogle Scholar
  31. 31.
    Diaz-Douton F, Benito A, Pujol J, Arjona M, Guell JL, Artal P (2006) Comparison of the retinal image quality with a Hartmann–Shack wavefront sensor and a double-pass instrument. Invest Ophthalmol Vis Sci 47:1710–1716PubMedCrossRefGoogle Scholar
  32. 32.
    Martinez-Roda JA, Vilaseca M, Ondategui JC, Giner A, Burgos FJ, Cardona G, Pujol J (2011) Optical quality and intraocular scattering in a healthy young population. Clin Exp Optom 94:223–229PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kwanghyun Lee
    • 1
  • Ji Min Ahn
    • 1
  • Eung Kweon Kim
    • 1
    • 2
  • Tae-im Kim
    • 1
    Email author
  1. 1.The Institute of Vision Research, Department of OphthalmologyYonsei University College of MedicineSeoulRepublic of Korea
  2. 2.Severance Biomedical Science Institute, Brain Korea 21 Project for Medical ScienceYonsei University College of MedicineSeoulRepublic of Korea

Personalised recommendations