Which is superior: LASIK or contact lenses?

New Orleans-When compared with daily contact lens wear, wavefront-guided LASIK results in better binocular uncorrected visual acuity and comparable subjective outcomes, according to a study presented here during the American Society of Cataract and Refractive Surgery meeting.

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Steven Dell, MD, and Steve Schallhorn, MD, compared the visual and subjective outcomes in patients who wear contact lenses with those who underwent wavefront-guided LASIK for the correction of myopia and astigmatism.

This was a retrospective review, and all groups had similar baseline demographics, Dr. Dell said. With 1,232 contact lens wearers, 3,502 post-LASIK patients (1 month postoperatively), and 1,351 post-LASIK patients (5 years postoperatively), “this is one of the largest retrospective reviews,” Dr. Dell said.

Patients included in the analysis were between 18 to 39 years of age, and had baseline myopia between 0.25 D and 6.0 D. There was no more than 1.5 D of corneal astigmatism in any group. The endpoints included monocular and binocular distance visual acuity at 1 month, and subjective outcomes at 1 month and 5 years.

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All LASIK was performed on the iDesign (Abbott Medical Optics) platform, Dr. Dell said.

“At 1 month postop, binocular distance visual acuity of 20/16 was achieved by 81% of daily wear contact lens wearers with best correction versus 96% of LASIK patients without correction,” he said.

PROWL-1 study

The PROWL-1 study, completed in 2014 with 262 participants, was conducted at the U.S. Naval Medical Center San Diego, and used a questionnaire to determine patient-reported outcomes (PRO) in a patient population undergoing LASIK, Dr. Dell said. The intent behind PROWL-1 was to develop a questionnaire to better evaluate patients’ reporting of visual symptoms and to assess the potential of those symptoms to impact a patient’s quality of life after LASIK.

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“What PROWL taught us is it doesn’t take 5 years for LASIK complaints to abate,” Dr. Dell said. “There is an initial spike in complaints at postop month 1, but at 5 years those complaints are similar to what the preop levels were.”

Further, after 6 months, 96% of patients in the PROWL-1 study were satisfied with the outcomes, and Dr. Dell’s study reinforced those findings.

In PROWL, the majority of patients had gained ≥1 line of best-corrected visual acuity compared with preoperatively, no patient had lost >1 line of BCVA, 98% of patients were satisfied with the result of their surgery, and 97% were satisfied with their vision.

Complaints and symptoms

Complaints and symptoms

Contact lens complaints/symptoms were reported by 52% of lens wearers, with dry eye (17.4%), irritation/discomfort (11.1%), and red eye (5.2%) being the most common complaints. The majority of patients (≥89%) with contact lens wear and LASIK reported none/mild for difficulty with halo, glare, or dry eye, with LASIK symptoms lessening in severity from 1 month to 5 years, Dr. Dell said

Those dry eye complaints “are cut in half by month 6,” he said.

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“Let’s not forget that contact lens wearers also have their own problems: 52% have complications with their lens wear, and of those, 19% have had infections associated with contact lens use,” he said.

Postoperatively, 79.5% of LASIK patients had no complaints, compared with only 27.8% of contact lens wearers.

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“Quality of life is better in the LASIK group, too, with 97.9% of LASIK patients saying the procedure had improved their quality of life, which increased to 98.5% by postop month 1,” he said.

Conversely, Dr. Dell said, most contact lens wearers are going to develop issues, and 8.3% of the respondents reported multiple issues (infections and discomfort, for example).

Dr. Dell is a consultant to Abbott Medical Optics and Optical Express.