LASIK rivals contact lenses in visual acuity and comfort

Reviewed by Steven Dell, MD

A comparison of patients using daily wear contact lenses (CLs) and those who underwent wavefront-guided LASIK strongly indicated that the latter provides better subjective results and better binocular uncorrected visual acuity.

Sponsored: 5 reasons toric IOLs are the best choice for managing astigmatism

Those were the findings of a retrospective, comparative multicenter study of the two types of vision correction undertaken by Steven Dell, MD, and Steven Schallhorn, MD. Drs. Dell and Schallhorn are in private practice in Austin, TX, and San Diego, respectively.

Related: Looking back—and ahead—at LASIK’s potential

Patients who underwent LASIK were evaluated 1 month and 5 years after the procedure.

The patients who participated in the study were aged 18 to 39 years, had myopia ranging from 0.24 to 6 D and astigmatism up to 1.5 D. All patients had best-corrected visual acuity of 20/40 or higher.

The study groups included 1,232 patients who wore CLs habitually, 3,502 patients who underwent LASIK and completed the 1-month post-LASIK evaluation, and 1,351 patients who completed the 5-year post-LASIK evaluation. Study endpoints were monocular and binocular distance visual acuities at 1 month and the subjective outcomes at 1 month and 5 years postoperatively.

Recent: Technique targets source of rainbow glare symptoms

The vast majority of the CL wearers used daily disposable soft lenses (49.3%) and frequent replacement soft lenses (38.5%).

Drs. Dell and Schallhorn reported that at 1 month postoperatively, the monocular visual acuities were similar for CL and LASIK patients, with 85% and 88%, respectively, achieving 20/16.

The binocular distance visual acuity of 20/16 was achieved by 81% of CL wearers and 96% of LASIK patients without correction.

More: Learn how curiosity propels astigmatism innovations

Starbursts and halos

Starbursts and halos

When patients were questioned about the presence of starbursts and halos at night around bright lights, 1 month after LASIK, 4.6% of patients reported moderate starburst/halos at 1 month, which decreased to 2.4% at 5 years postoperatively. Of the CL wearers, 1.6% reported moderate starburst/halos and 1.3% reported severe starburst/halos. When asked about glare, the results were similar at 1 month for both treatments.

Related: Consider latest excimer laser techniques for presbyopia

Dry eye was slightly more problematic. Moderate dry eye symptoms were slightly increased at the 1-month time point, but at 5 years, similar numbers of patients had no dry eye symptoms, i.e., 5.5% and 8.7% for CL wears and LASIK patients, respectively. At the 5-year evaluation, the respective percentages declined to 3.8% and 5.6%. 

The authors reported that overall, 52% of CL wearers had symptoms/complaints with their lenses, with dry eye (18.8%), irritation/discomfort (11.2%), and red eye (5.2%) the most common complaints. Nineteen percent of contact lenses wearers had an infection related to their CLs, and 8.3% had multiple infections related to their CLs.

Which is superior: LASIK or contact lenses?

Comparison of the discomforts experienced with CLs and those experienced after LASIK indicated that the advantage for LASIK was three times that of CLs, specifically, 27.8% of CL wearers never had a problem with their CLs compared with 79.5% of LASIK patients who never had a problem with discomfort after LASIK.

Patients in this study overwhelmingly reported that LASIK improved their lives, i.e., 97.9%, according to investigators. When asked to compare their vision with glasses or CLs before LASIK, 98.5% of patients said their vision was equal to or better than that achieved with glasses and CLs.

Related: When is crosslinking appropriate?

Drs. Dell and Schallhorn concluded, “For CL wearers, more than half of patients (52%) reported problems with their contact lenses, 19% reported having had a CL-related infection, and 8.3% reported having multiple CL-related infections.”

For those who underwent LASIK, the procedure was arguably safer than long-term CL wear, they noted.

There was almost a three times lower prevalence of ocular discomfort compared with CLs. More patients achieve 20/16 binocular vision. There were no long-term differences in the incidence rates of glare, halo starburst symptoms, or dry eye symptoms.

More: Keratoconus as refractive surgery—thinking outside the ‘cone’

Steven Dell, MD

E: steven@dellmd.com

Drs. Dell is a consultant to Abbott Medical Optics, Advanced Tear Diagnostics, Allergan, Bausch + Lomb, Lumenis, Ocular Therapeutix, Optical Express, Presbyopia Therapies, and Tracey Technologies.

Steven Schallhorn, MD

Dr. Schallhorn is a consultant to Abbott Medical Optics, AcuFocus, Carl Zeiss Meditec, and Ivantis.