Purpose: To compare preoperative and postoperative changes in simulated night driving performance after wavefront-guided (wLASIK) and conventional LASIK (cLASIK) for the treatment of moderate myopia.
Design: Retrospective, comparative study.
Participants: All eyes of subjects with a preoperative manifest spherical equivalent (MSE) between -4.50 and -6.00 who underwent night driving simulator (NDS) testing from 2 clinical trials were entered into the study. This comprised 38 cLASIK patients (62 eyes; mean -5.46 diopters [D] MSE) and 21 wLASIK patients (36 eyes, mean -5.20 D MSE).
Methods: Patients' records were reviewed from 2 LASIK clinical trials that had similar enrollment criteria. One trial treated patients with conventional LASIK using a bladed microkeratome (cLASIK) and the other treated with a wavefront-guided profile using a femtosecond laser (wLASIK). In both trials, patients with moderate myopia were asked to participate in NDS testing.
Main outcome measures: The detection and identification distances of road hazards were measured with and without a glare source before and 6 months after LASIK. Each eye was tested independently in best-corrected trial frames by a masked operator.
Results: In every category, there was a mean reduction in the preoperative to postoperative NDS performance after cLASIK (mean change, -21.3 to -27.9 ft, -6.5 to -8.5 m; 95% confidence interval [CI], -12.0 to -41.3 ft, -3.7 to -12.6 m); there was a corresponding mean improvement after wLASIK (mean change +15.0 to +29.1 ft, +4.6 to +8.9 m; 95% CI, +8.3 to +41.5 ft, +2.5 to +12.6 m). Significant differences between cLASIK and wLASIK NDS performance was observed in every category (P<0.;01, Tukey's honest significant difference for unequal numbers). A clinical relevant loss of NDS performance (>0.5 seconds) was observed in 32% to 38% of cLASIK eyes for all tasks, whereas only 0% to 3% of eyes had this loss after wLASIK. Between 2% and 7% of cLASIK eyes and 11% and 31% of eyes had a significant postoperative improvement in NDS performance in every task.
Conclusions: Wavefront-guided LASIK to correct myopia combined with a femtosecond laser flap significantly improved mean night driving visual performance and was significantly better than cLASIK using a mechanical keratome.