Wavefront-guided customized corneal ablation

Purpose of Review: This review highlights some of the advantages and limitations with our current wavefront technology and reviews the evidence supporting the efficacy and safety of wavefront-guided corneal ablations. Recent Findings: While older studies often assessed visual outcomes based upon visual acuity, recent studies incorporate more sensitive parameters to assess quality of vision and to better understand the impact of high-order aberrations. Recently, the US Food and Drug Administration approved wavefront-guided monovision for mild to moderate myopia. Advances in wavefront sensing and laser technology continue to improve outcomes with wavefront-guided corneal ablations in primary treatments and enhancements. In addition to ablations based upon mapping of total ocular aberrations, customized ablations that integrate topographical data appear to be promising. Lastly, femtosecond laser technology allows for flap creation that induces less change in high-order aberrations and corneal biomechanics. Summary: Wavefront guided customized corneal ablations are safe, effective, and predictable. Compared with conventional treatments, wavefront-guided ablations can achieve a reduction in preexisting higher-order aberrations and less induction of new higher-order aberrations, resulting in improved outcomes with contrast sensitivity and visual symptoms under mesopic and scotopic conditions. Wavefront technology is still evolving to address current limitations and to optimize customization of corneal ablations.