Visual performance after photorefractive keratectomy with a 6-mm ablation zone

PURPOSE: To prospectively examine the effect of photorefractive keratectomy with a 6-mm ablation zone on best spectacle corrected visual performance. METHODS: A prospective study was conducted of 164 eyes of 164 patients with an average (+/-SD) of -4.02 +/- 1.74 diopters (range, -0.63 to -8.38 diopters spherical equivalent). Best-spectacle-corrected high contrast and low contrast visual acuity (18% Weber contrast) was measured with both natural and dilated pupils. Patients were tested preoperatively and at 3, 6, and 12 months after photorefractive keratectomy, Photorefractive keratectomy was performed with an argon fluoride excimer laser. Fifty-five eyes of 55 patients also underwent astigmatic keratotomy, RESULTS: Twelve months after photorefractive keratectomy, best-spectacle corrected high-contrast visual acuity with natural pupils showed no significant change from preoperative values; mean (+/-SD) change was 0.004 +/- 0.10 logMAR (t = 0.45, P = .65). Best-spectacle-corrected low-contrast visual acuity with natural pupils was significantly reduced compared to baseline; mean (+/-SD) change was 0.04 +/- 0.13 logMAR (t = 3.3, P = .001). The low-contrast loss was larger (1.5 lines) with dilated pupils; mean (+/-SD) change was 0.13 +/- 0.15 logMAR (t = 9.31, P < .001). Greater losses in dilated low-contrast visual acuity were associated with concurrent astigmatic keratotomy (t = 2.28, P = .025) and corneal haze of grade 1 or greater (t = 2.71, P = .005), CONCLUSIONS: Reductions in visual performance oc cur after photorefractive keratectomy with a 6 mm zone. These changes are greatest for low contrast visual acuity with dilated pupils, Corneal haze and concurrent astigmatic keratotomy are associated with greater losses in low-contrast visual acuity, Best spectacle-corrected lowe contrast visual acuity is a sensitive measure for evaluating visual performance after refractive surgery, (Am J Ophthalmol 1999;128:1-7, (C) 1999 by Elsevier Science Inc. All rights reserved.)