Purpose: To determine the incidence and independent predictors of incomplete corneal epithelialization at the one-week visit after photorefractive keratectomy (PRK), accounting for correlation between fellow eyes. Setting: A high-volume refractive-surgery network, Israel. Design: Retrospective registry-based cohort study. Methods: 37,982 eyes of 18,991 patients who underwent bilateral same-session PRK (January 2013-June 2024), examined on postoperative days 5-9. The outcome was modeled by generalized estimating equations (logistic; exchangeable correlation, robust standard errors) clustered on patient. Visit day and optical zone were also modeled categorically; surgeon was examined as a covariate and a clustering level. Results: Incomplete epithelialization occurred in 1,804 of 37,982 eyes (4.8%; 95% CI, 4.5-5.0). Rates were 17.2%, 5.5%, 4.3%, 4.1% and 3.3% on days 5 through 9. Day 5 carried almost five-fold the odds of day 7 (OR 4.78; 95% CI, 3.73-6.13) and day 6 remained elevated (OR 1.30; P=0.003); days 8-9 did not differ significantly from day 7. No surgical parameter was consistently associated with the outcome. Preoperative spherical equivalent, null in the primary model, was associated once surgeon was accounted for (OR 0.93 per +1 D; P=0.019). An affected eye predicted an affected fellow eye in 73.3% of affected eyes, against 1.33% of healed eyes. Conclusions: At one week, incomplete epithelialization is uncommon, is concentrated at day 5, and resolves gradually to a stable baseline by day 7, consistent with assessment timing rather than a distinct entity, and supporting a day-7 review default. It is predominantly patient-level, and no surgical parameter was consistently associated with it.
Purpose: To evaluate the association between binocular uncorrected visual acuity (UVA) at different distances and patient-reported difficulty with individual VF-14 activities after implantation of simultaneous vision intraocular lenses (SVIOLs). Setting: (“Masked by journal requirement”) Design: Retrospective observational Methods: Twelve-month data from 276 subjects implanted with either a Full-DOFi Smooth or a Partial-DOFi Extended IOL were included in the analysis. Visual acuities were obtained for far (UDVA, 4 m), intermediate (UIVA, 66 cm), and near (UNVA, 40 cm) distances, along with responses to a validated Spanish version of the VF-14 administered without spectacles. VF-14 responses were dichotomized (little/no vs other), and logistic regression analyses were performed to examine their associations with UDVA, UIVA, and UNVA. Statistical cut-off values were explored using the Youden index. Results: UDVA was significantly associated with “traffic signs” and “night driving” (p < 0.05), whereas “watching TV” showed p = 0.06. UNVA was significantly associated with “knitting” (p < 0.05), whereas “large print” showed p = 0.06, and UIVA was associated with “newspapers” (p = 0.02). “Small print” and “knitting” were associated with both UIVA and UNVA, whereas “filling out forms” was associated only with UNVA (p < 0.05). Visual acuities were not associated with the remaining VF-14 items. Exploratory cut-off values maximizing the Youden index were generally 0.1 logMAR, except for “large print” (0.3 logMAR) and “traffic signs” (0.2 logMAR). Conclusions: Only some VF-14 items were associated with binocular UVA. These findings may inform the development of PRO instruments for evaluating functional differences among SVIOLs.
Purpose: Intraindividual comparison of treatment-induced changes of ocular higher-order aberrations (HOAs) after ray-tracing-guided laser in situ keratomileusis (LASIK) and wavefront-optimized LASIK. Setting: University hospital. Design: Prospective, randomized, eye-to-eye comparative study. Methods: Patients with myopia and myopic astigmatism underwent ray-tracing-guided wavelight plus (Alcon) LASIK in one eye and wavefront-optimized LASIK in the fellow eye. The study assessed treatment-induced changes (3 months postoperative - preoperative) in root-mean-square (RMS) of total HOAs, primary spherical aberration, RMS coma and RMS trefoil after wavelight plus and wavefront-optimized LASIK. Results: Thirty patients (sixty eyes) were included in the study. The mean change (± standard deviation) in RMS of total HOAs at 6-mm zone of analysis was 0.00±0.15µm after wavelight plus (p=0.758) and 0.11±0.12µm after wavefront-optimized LASIK (p<0.001). A negative spherical aberration change of -0.07±0.13µm (p=0.012) occurred after wavelight plus and a positive change of 0.06±0.09µm (p<0.001) after wavefront-optimized treatment. Changes in coma and trefoil were 0.02±0.15µm (p=0.474) and -0.02±0.10µm (p=0.225) after wavelight plus, while after wavefront-optimized LASIK they were respectively, 0.10±0.13µm (p<0.001) and 0.02±0.06µm (p=0.058). In contralateral-eye comparison, wavelight plus resulted in lower total HOAs in all patients with elevated preoperative HOAs (RMS of total HOAs >0.30µm, n=13 patients) and in 70.6% of patients (n=12) with low preoperative HOAs (≤0.30µm, n=17 patients). Conclusions: Wavefront-optimized LASIK increased total HOAs, spherical aberration and coma, while no increase in HOAs was detected after wavelight plus. Spherical aberration decreased (negative change) after wavelight plus. The benefit of ray-tracing-guided LASIK tended to be larger in patients with higher preoperative HOAs.
Topic: To compare efficacy, refractive predictability, safety, and early recovery after single-step transepithelial photorefractive keratectomy (TransPRK) using StreamLight and SmartSurfACE in myopic eyes through network meta-analysis. Clinical relevance: TransPRK is a flap-free surface ablation option for myopic patients. Direct comparative evidence between TransPRK technologies remains limited. Methods: PubMed/MEDLINE, Embase, Cochrane Central, and Web of Science were searched from inception to October 31, 2025. Randomized trials, cohort studies, and case series evaluating single-step TransPRK using StreamLight or SmartSurfACE were included. Alcohol-assisted photorefractive keratectomy (aaPRK) served as the common comparator. Random-effects network meta-analysis was performed. Results: Forty-two studies were included; 15 contributed to the network meta-analysis. No significant differences were detected between StreamLight and SmartSurfACE in efficacy (uncorrected distance visual acuity [UDVA] ≥20/20; odds ratio [OR] 0.75, 95% confidence interval [CI] 0.13–4.22), predictability (±0.50 diopters; OR 1.11, 95% CI 0.27–4.61), postoperative spherical equivalent (standardized mean difference [SMD] 0.02, 95% CI −0.31 to 0.35), or safety index (SMD −0.28, 95% CI −1.89 to 1.34). Loss of ≥2 lines of corrected distance visual acuity (CDVA) was rare. StreamLight was associated with faster epithelial healing (SMD −2.03, 95% CI −3.26 to −0.80), approximately 1–1.5 days earlier. Pain and haze were similar. No significant inconsistency was detected. Conclusion: No significant differences were detected between StreamLight and SmartSurfACE in efficacy, refractive predictability, or safety for myopic TransPRK. The observed epithelial-healing advantage with StreamLight was based on indirect evidence and should be interpreted cautiously.
