Custom LASIK or Wavefront LASIK:
Individualized Vision Correction

Custom LASIK surgery, also known as wavefront LASIK or wavefront-guided LASIK, uses 3-dimensional measurements of how your eye processes images to guide the laser in re-shaping the front part of the eye (cornea).

With a wavefront measurement system, some extremely precise, individualized vision correction outcomes may be achieved that would be impossible with traditional LASIK surgery, contact lenses or eyeglasses.

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You should be qualified under Food and Drug Administration guidelines before custom wavefront LASIK would be considered for your eye condition. Depending on the custom laser system used and other factors such as appropriate thickness of your cornea, you might be considered a candidate if you have mild to moderately high degrees of common vision defects such as myopia, hyperopia and astigmatism.

With custom LASIK, your eye's ability to focus light rays is measured, and a 3-D map is created that demonstrates irregularities in the way your eye processes images. Information contained in the map guides the laser in customizing the treatment to reshape your eye's corneal surface so that these irregularities can be corrected. [See also: Wavefront Technology in Eye Exams]

Standard prescriptions for glasses, contacts, or traditional LASIK procedures can correct ordinary vision defects such as myopia, hyperopia, and astigmatism. But other irregularities associated with the eye's optical system could not be addressed until the advent of wavefront and related technology used in custom LASIK.

Wavefront technology is groundbreaking because it has the potential to improve not only how much you can see, visual acuity measured by the standard 20/20 eye chart, but also how well you can see, in terms of contrast sensitivity and fine detail. This translates into a reduced risk of post-LASIK complications, such as glare, halos, and difficulty with night vision.

How much you see depends on vision defects known as lower-order aberrations associated with common refractive errors including myopia, hyperopia, and astigmatism, which traditional LASIK can treat.

How well you see can depend on presence of the type and numbers of visual distortions known as higher-order aberrations, which can include irregularities other than common refractive errors. These higher-order aberrations can create problems such as decreased contrast sensitivity or night vision, glare, shadows, and halos. However, higher-order aberrations do not always affect vision. Unlike traditional LASIK, custom LASIK treats both lower- and higher-order aberrations. [See also: What Are Higher-Order Aberrations?]

Custom LASIK's advantage lies in the area of quality of vision:

• Greater chance of achieving 20/20 vision
• Greater chance of achieving better than 20/20 vision
• Reduced chance of losing best-corrected vision
• Reduced chance of losing visual quality or contrast sensitivity
• Reduced chance of night-vision disturbances and glare
   

Potential also exists for custom LASIK to treat those people who have lost best-corrected vision from any past refractive surgery: LASIK, PRK, RK, etc.

"Sometimes patients complain about vision quality problems, such as not being able to see in dim or low light. This is referred to as poor contrast sensitivity," said Roger Steinert, MD, associate clinical professor of ophthalmology, Harvard Medical School.

"Prior to the advent of wavefront measurements, there wasn't anything we could do to measure or treat higher-order aberrations," Steinert said. "With this technology breakthrough, we can now measure these disorders, show the patient what's going on in their eye, link that information to the laser, and actually correct higher-order aberrations that diminish contrast sensitivity. Wavefront technology enables the surgeon to improve overall vision quality better than in the past."

Not all refractive surgeons agree that wavefront-guided LASIK can treat higher order aberrations. In fact, some surgeons argue that both wavefront LASIK and conventional LASIK can sometimes cause these aberrations because of artificial changes made to the natural shape of the eye's surface. However, wavefront-guided LASIK may be less likely to induce higher order aberrations than conventional LASIK, according to discussion in the April 15, 2005 issue of Ophthalmology Times.

A 2005 survey revealed that most refractive eye surgeons now use wavefront-guided LASIK in their practices. Read more about the study in the sidebar:

The surgeon in one popular method will begin by using the wavefront device to transmit a safe ray of light into your eye. The light is then reflected back off the retina, out through the pupil, and into the device, where the reflected wave of light is received and arranged into a unique pattern that captures your lower- and higher-order aberrations.

All of these visual irregularities are then displayed as a 3-D map, referred to as a wavefront map. This information is then electronically transferred to the laser (in wavefront-guided systems), and computer-matched to the eye's position, enabling the surgeon to customize the LASIK procedure to your unique visual requirements.

Numbers of LASIK procedures in general grew significantly in 2004 and 2005, with many leading LASIK surgeons reporting in publications such as EyeWorld (published by the American Society of Cataract and Refractive Surgery) that most eligible patients were opting for more expensive custom LASIK. The advent of custom LASIK also appears to be contributing to increased public interest in undergoing LASIK. Review of Optometry in its October 2004 edition predicted about 1.35 million total LASIK procedures would be performed in the United States by the end of the year, up from 1.15 million procedures in 2003. About 1.45 million U.S. LASIK procedures were predicted for 2005*, though analysts feel that number may be revised because of fewer than expected procedures being performed in southern states that were affected by Hurricane Katrina. A 2006 Staar Surgical report estimates that about 1.4 million LASIK procedures currently are performed annually in the United States, about half of all procedures worldwide.

Custom LASIK usually costs significantly more than traditional LASIK, partly because a fee is paid to the device manufacturer for each procedure. For more information on custom LASIK pricing, please see our article on the cost of refractive surgery.

Research is continuing into expanding the degree of vision errors (such as high myopia) that can be corrected with custom LASIK. Investigations also are underway for use of custom LASIK to create multifocal corrections, which would enable older eyes that have developed presbyopia to see at near, middle, and distant ranges at the same time.

Like conventional LASIK, custom LASIK won't cure all vision-related problems, so it's important to discuss its applications with your eye doctor or surgeon to determine if you are a good candidate.