Update on customized wavefront-guided versus wavefront-optimized excimer laser ablation: Next steps in the quest for perfect vision

The pace of advancement in refractive surgical techniques and evolution of technology in recent years has been remarkably brisk. The increase in technologies and treatment options, however, has left many ophthalmologists uncertain as to which are the optimal choices for their patients and practices. Some of this dilemma undoubtedly arises from the expanding ‘alphabet soup’ of refractive technical terms: radial keratotomy (RK), astigmatic keratotomy (AK), limbal-relaxing incisions (LRI), photorefractive and astigmatic keratectomy (PRK) and (PARK), laser in situ keratomileusis (LASIK), laser subepithelial keratomileusis (LASEK), epithelial laser in situ keratomileusis (Epi-LASIK), IntraLase LASIK (Intra-LASIK), intracorneal ring segments (ICRS), laser thermokeratoplasty (LTK), conductive keratoplasty (CK), phakic intraocular lenses (PIOL), clear lens extractions (CLE), refractive lens exchange (RLE) and scleral expansion (SE), to name just a few. Within the parameters of a single technology, such as laser vision correction (LVC), there are numerous approaches to optimizing visual outcomes. For example, in the last 5 years, the development of wavefront technology has revolutionized the way refractive surgeons view and treat refractive error. The discussion continues, however, as to when or how to best use this technology. To date, there are two wavefront-based approaches to LVC: wavefront guided and wavefront optimized. The purpose of this article is to discuss the use of wavefront analysis and to explore wavefront-guided and wavefront-optimized approaches in LVC.