Ray-Tracing-Guided Femtosecond LASIK: Refractive Outcomes, Visual Quality and Patient Satisfaction

Purpose: To assess the refractive outcomes, visual quality, and patient satisfaction after ray-tracing-guided femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the correction of moderate-to-high myopia and myopic astigmatism. Methods: In this consecutive case series retrospective study, 51 patients (101 eyes) with moderate-to-high myopia and myopic astigmatism underwent ray-tracing-guided FS-LASIK. Visual acuity, manifest refraction, objective and subjective visual quality, patient satisfaction were assessed over 3 months. For objective visual quality, InnovEyes Sightmap was used to measure the higher-order aberrations (HOAs) over 5-mm optical zone, and Optical Quality Analysis System II was used to evaluate the modulation transfer function cut off (MTF cut off ) frequency, Strehl ratio (SR), and ocular scattering index (OSI). Subjective visual quality was evaluated utilizing the National Eye Institute Refractive Error Quality of Life (NEI-RQL) questionnaire. Results: Regarding visual and refractive outcomes, at 3 months, uncorrected distance visual acuity reached ≥ 20/20 in all eyes, ≥ 20/16 in 69% of eyes, and ≥ 20/12.5 in 18% of eyes. Best-corrected distance visual acuity was better in 61% of eyes. All eyes achieved manifest refractive spherical equivalent within ± 1.00 D and 86% of eyes achieved cylinder within ± 0.25 D. As for objective visual quality, total HOA increased significantly ( P < 0.001), whereas spherical aberration showed no significant change ( P = 0.225); no changes were found in MTF cut off , SR, and OSI (all P > 0.05). In terms of subjective visual quality, 100% of patients reported clear distance vision, and 96.10% had no near-reading difficulty. Investigation of patient satisfaction showed that 98.04% of patients were satisfied with the surgery, 98.04% would recommend it to others. Conclusion: Ray-tracing-guided FS-LASIK may be an effective, safe and predictable procedure for moderate-to-high myopia and myopic astigmatism. It yielded favorable refractive outcomes, maintained objective visual quality, and achieved high patient satisfaction. Keywords: ray tracing, FS-LASIK, refraction, visual quality, patient satisfaction