Ray-Tracing-Guided Femtosecond LASIK: Refractive Outcomes, Visual Quality and Patient Satisfaction

Linjuan Yang,1,* Lei Luo,1,* Yu Zhang,1 Yimeng Fan,1 Xindi Wang,1 Qianrong Hu,1 Yan Cai,1 Shimin Tan,2 Jingni Yu,3 Zhao Liu,1 Shengjian Mi1 1Department of Ophthalmology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2Department of Ophthalmology, Xi’an No.9 Hospital, Xi’an, Shaanxi, People’s Republic of China; 3Department of Ophthalmology, Xi’an People’s Hospital, Xi’an, Shaanxi, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhao Liu, Department of Ophthalmology, the First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an, Shaanxi, 710061, People’s Republic of China, Tel +86 029 85324452, Email [email protected]: To assess the refractive outcomes, visual quality, and patient satisfaction after ray-tracing-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the correction of moderate-to-high myopia and myopic astigmatism.Methods: In this consecutive case series retrospective study, 51 patients (101 eyes) with moderate-to-high myopia and myopic astigmatism underwent ray-tracing-guided FS-LASIK. Visual acuity, manifest refraction, objective and subjective visual quality, patient satisfaction were assessed over 3 months. For objective visual quality, InnovEyes Sightmap was used to measure the higher-order aberrations (HOAs) over 5-mm optical zone, and Optical Quality Analysis System II was used to evaluate the modulation transfer function cut off (MTFcut off) frequency, Strehl ratio (SR), and ocular scattering index (OSI). Subjective visual quality was evaluated utilizing the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire.Results: Regarding visual and refractive outcomes, at 3 months, uncorrected distance visual acuity reached ≥ 20/20 in all eyes, ≥ 20/16 in 69% of eyes, and ≥ 20/12.5 in 18% of eyes. Best-corrected distance visual acuity was better in 61% of eyes. All eyes achieved manifest refractive spherical equivalent within ± 1.00 D and 86% of eyes achieved cylinder within ± 0.25 D. As for objective visual quality, total HOA increased significantly (P < 0.001), whereas spherical aberration showed no significant change (P = 0.225); no changes were found in MTFcut off, SR, and OSI (all P > 0.05). In terms of subjective visual quality, 100% of patients reported clear distance vision, and 96.10% had no near-reading difficulty. Investigation of patient satisfaction showed that 98.04% of patients were satisfied with the surgery, 98.04% would recommend it to others.Conclusion: Ray-tracing-guided FS-LASIK may be an effective, safe and predictable procedure for moderate-to-high myopia and myopic astigmatism. It yielded favorable refractive outcomes, maintained objective visual quality, and achieved high patient satisfaction.Keywords: ray tracing, FS-LASIK, refraction, visual quality, patient satisfaction