With standard LASIK, you essentially receive what's in your prescription glasses or contacts lenses permanetly on your cornea to treat your nearsightedness, farsightedness, or astigmatism. With custom (Wavefront) LASIK, you receive that correction plus the correction for about a dozen other characteristics of your eyes that contribute to blurry vision (like distortion around headlights when you drive at night.) We charge the same at our practice for Custom and standard LASIK to make the decision easy for our patients. Go with the best technology--you won't regret it!
Lasik Vs. Wavefront Lasik - What's the Difference?
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Standard vs. Custom LASIK
LASIK versus Wavefront
This terminology can get confusing. The only procedure I do any longer is Wavefront LASIK. What this means is that your eyes are individually mapped and "fingerprinted" which identifies your specific "nooks and crannies." Then this information is downloaded to the excimer laser and this specific pattern is treated. The results are better and there is less induced glare, halos, etc. "Standard" LASIK is an older term in which this mapping is not performed and your laser treatment is subsequently more generic. In 2010 you should be getting wavefront LASIK. Beware of centers offering standard LASIK for a lower fee. It is 2010, why would you sign up for a 2004 treatment?
New information on Customized LASIK
LASIK is the correction of "lower order aberrations" which is exactly what glasses correct. Wavefront or Custom LASIK was developed to treat small imperfections in the vision but in reality mostly was helpful in reducing the creation of new aberrations that were a side effect of the laser treatment. These corrections were popular at first but didnt always fix the lower order aberrations as well and thus not as popular as was originally hoped. Wavefront optimized is the current state of the art for most people since this maintains the normal shape of the eye and induces few new aberrations while very effectively treating the lower order aberrations giving most patients the desired 20/20 result that they seek.
There are several laser platforms that provide this optimized custom treatment. Some patients need a more customized treatment, and for these patients, a topography guided treatment or topo guided may be best. This is because we only want to fix the aberrations which come from the cornea when we laser treat the cornea, and not those from other eye structures such as the lens.
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Customized Wavefront Lasik treatment
Wavefront technology is utilized to provide a mapping of one's unique characteristics of their eye, much like a fingerprint.
This technology was adapted from astronomy 25 years ago to look at distant stars traveling the atmosphere. Now, we utilize this technology to provide information about the prescription as well as the unique small irregularities of one's eye. This technology allows us to measure the prescription of one's eyes 25 times more accurately!
Utilizing this technology, we can personalize the laser vision correction treatment which is unique to your eyes. This enables almost everyone to achieve 20/20 or better vision. More people are also satisfied with their nighttime vision after the surgery than they were with glasses or contact lenses.
LASIK vs. Wavefront LASIK
Conventional LASIK treats your eyes based on your glasses prescription. Wavefront LASIK creates a custom map of your corneas and treats based on that. With conventional LASIK about 92% of patients get to 20/20 vision or better. With wavefront 98% achieve 20/20 or better. Wavefront also significantly reduces the chance of glare and halos at night.
Important Distinction Between Wavefront LASIK and Custom LASIK
This is a very important distinction for patients to understand. A Wavefront Custom procedure measure the refractive error (nearsightedness, astigmatism) as well as optical abberations or "wavefront errors". Every eye focuses light different across the pupil, and the Wavescan creates a unique treatment for each eye. This treatment is then downloaded into the laser (I prefer the Visx Customvue), the laser identifies the patient's eye by an iris fingerprint, and orients/aligns the treatment with the IR - iris registration. A custom treatment provides better night vision, better quality of vision, and a higher % of 20/20.
I reported 14,000 Custom iLasik procedures performed over a 7 year period and at 1 month 94% were 20/20 or better, and at 6 months 97% were 20/20 or better. I reported 1,000 consecutive eyes from 2010 and 98% were 20/20 or better and more than half were 20/15, better than 20/20. These results cannot be duplicated by non-custom or "custom-adjusted" LASIK.
Wavefront LASIK optimizes and invidualizes vision correction
There are significant differences between wavefront-guided LASIK and conventional LASIK. First, there is a difference in the way the eye is measured. Wavefront-guided LASIK uses a wavefront scanner to measure the passage of light from the front surface of the eye to the back, creating a unique wavefront map for each eye. Second, the laser treatment is more precise, removing more of the aberrations that cause glare and halos. The data shows that wavefront-guided LASIK outcomes are better than conventional LASIK with a higher percentage of patients achieving 20/20 vision or better.
Custom customvue wavefront hi-def LASIK vs LASEK
Everybody who qualifies and can afford it should get WaveFront or Custom or CustomVue or Hi-Def LASEK or LASIK, not standard.
I know this as a patient, as I got non-wavefront LASIK a decade ago, before WaveFront came out, so I have some halos around lights at night. This problem is eliminated with WaveFront, as you can put a slightly higher Rx on the periphery of the cornea, which is necessary, as you actually need a higher Rx at the edge of your eye.
CustomVue on the VISX laser I use treats 25 times more accurately than the standard treatment I had done a decade ago--to the nearest +/- 0.01, not +/- 0.25 like in glasses or contacts (e.g. -3.00 or -3.25, nothing in-between).
I switched to CustomVue LASEK as you get an EVEN MORE ACCURATE TREATMENT IF YOU DON'T CUT A FLAP SO THE VISION IS EVEN SHARPER AFTERWARDS. Published studies have shown that if you cut a flap in LASIK, the WaveFront map, because it's so accurate, is changed and distorted by just cutting the flap. So the only TRUE CUSTOM LASIK would be to cut the flap, take the patient out of the OR, do the WaveScan with the flap already cut and the patient walking around the office w a cut flap in their eye, then put them under the laser and shoot the WaveScan that was obtained AFTER THE LASIK FLAP WAS CUT.
Obviously, nobody does this in real life, for 2 reasons: 1) the "through-put" of the laser would be awful, so you could only treat 1-2 patients per day, and 2) people would be skeeved out waking from the OR to the WaveScan and back to the OR with the flap cut in their eyes.
This is why, since I switched from LASIK to LASEK in 2005, the number of patients who see BETTER than 20/20 DOUBLED. Not the number of people 20/20, as you can get someone to 20/20 with a flap that's a tiny bit misaligned, and a WaveScan that's a bit distorted from the true scan you would get after cutting the flap.
You also avoid the dry eyes and night glare by not cutting a flap, as the former is caused by cutting the corneal nerves when you cut the flap, and the latter is caused by the cornea being in a two-piece "sandwich" configuration afterwards for the rest of your life.
So if you decide to do it right, and get CustomVue, I suggest you get a real custom, accurate, non-distorted result by electing to get CustomVue LASEK rather than the not-really-perfect custom LASIK I used to perform.
Traditional LASIK vs. Wavefront
Traditional LASIK corrects only your refractive errors (myopia, hyperopia or astigmatism) or what are also referred to as lower order optical aberrations. With wavefront LASIK we still correct lower order aberrations (myopia, hyperopia, astigmatism) but we also correct higher order aberrations which are unique to your eye and cornea. It is believed that by reducing both higher order and lower order aberrations the final visual outcome will be better.
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