Predictors of Visual Acuity Improvement in Patients With Amblyopia Following Laser Vision Correction Surgery

Purpose: To identify factors predicting a two-line (0.2 logarithm of the minimum angle of resolution [logMAR]) improvement in corrected distance visual acuity (CDVA) following laser vision correction surgery in patients with amblyopia. Methods: Consecutive patients with amblyopia undergoing primary laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) between 2013 and 2024 were included. Inclusion criteria were age older than 18 years, stable refraction for 12 months or more, myopia of −12.00 diopters (D) or less, hyperopia of +6.00 D or less, and cylinder of 6.00 D or less. Amblyopia was classified as mild (CDVA better than 20/40) or moderate (CDVA worse than or equal to 20/40 and better than 20/80). Patients were grouped by CDVA improvement (⩾ 2 lines vs < 2 lines). Binary logistic regression identified predictors of CDVA improvement, including variables with P < .15 in univariate analysis. Results: Of 1,894 amblyopic eyes reviewed, 1,007 eyes met inclusion criteria. Two-line CDVA improvement was observed in 22.8% (n = 230). Predictors of improvement included younger age (odds ratio [OR]: 0.96 per year, P < .001), male gender (OR: 1.38, P = .04), and worse preoperative CDVA (OR: 1.67 per 0.1 logMAR unit, P < .001). Higher preoperative cylinder values were inversely associated with improvement (OR: 0.88 per diopter, P = .03). Patients in the improvement group were younger (27.3 ± 8.4 vs 30.9 ± 10.5 years, P < .001) and more likely to have moderate amblyopia (28.7% vs 21.5%, P = .03). Conclusion: Younger age, male gender, worse preoperative CDVA, and lower cylinder values are significant predictors of a two-line improvement in CDVA in patients with amblyopia undergoing LASIK or PRK. These findings can guide preoperative counseling and help set realistic expectations for this subset of patients.