Refractive and corneal analyses after custom-Q versus wavefront-optimized ablation in photorefractive keratectomy for myopia

Purpose To evaluate refractive and tomographical outcomes following Custom-Q without Q-adjustment and wavefront-optimized (WFO) photorefractive keratectomy (PRK) for myopia. Methods This retrospective, comparative study included 46 eyes in the Custom-Q group and 40 eyes in the WFO group who underwent PRK for myopia and/or myopic astigmatism. Planned central ablation depth (CAD), total laser pulses (from WaveLight EX500), and corneal thickness (CT) changes at central, paracentral (3.0 mm), and mid-peripheral (6.0 mm) zones (from Sirius tomography) were recorded with visual, refractive, and topographic outcomes preoperatively and at 6 months. Results Postoperative sphere was closer to emmetropia in the Custom-Q group (0.041 ± 0.17 D vs. −0.089 ± 0.30 D, p = 0.024), and postoperative flat keratometry was lower than in the WFO group (p = 0.045). For 1.00 D spherical equivalent (SE) correction, Custom-Q resulted in lower planned CAD, less CT change across all zones, and fewer laser pulses than WFO (p < 0.05 for all). Both groups showed comparable safety and efficacy indexes (>1.0), similar significant oblate shift, increased root-mean-square of higher-order aberrations 6mm (RMS-HOAs 6mm ), with no significant change in HOAs 3mm (p > 0.05 for all), while spherical aberration 6mm decreased more in the Custom-Q group (−0.080 ± 0.096 vs. −0.040 ± 0.102, p = 0.024, respectively). There was a significant correlation between preoperative SE and changes in asphericity 6mm (r = −0.853, p < 0.001), RMS-HOAs 6mm (r = −0.430, p = 0.008), and spherical aberration 6mm (r = 0.632, p < 0.001) in the Custom-Q group. Conclusions Custom-Q without Q-adjustment is an effective and safe option for myopic PRK, achieving better refractive precision and lower CT reduction per diopter than WFO, with improved control of spherical aberration despite comparable increases in asphericity and RMS-HOAs 6mm .