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Meta-analysis of Six Excimer Laser Platforms for Safety and Efficacy in
Myopic Laser-assisted in situ Keratomileusis
Christopher L Blanton, MD
President, Board of Directors; Chief Executive Officer, Inland Eye Institute Medical Group, Inc., Colton, California, US;
Adjunct Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, US
Abstract Purpose: To compare excimer laser platform outcomes for myopic laser-assisted in situ keratomileusis (LASIK). Methods: A peer-reviewed
literature search was conducted using the terms “myopia,” “LASIK,” and “outcomes.” Articles were selected based on inclusion/exclusion
criteria. Data regarding Snellen visual acuity, refractive error ± 0.5 and 1.0 diopter (D) and loss of best-corrected acuity were extracted. US
Food and Drug Administration (FDA) approval studies were used to fill in any data gaps. Statistical analysis was performed. Results: The
Abbott laser outperformed the other five in multiple measures of visual acuity results at 1 and 3 months. The Nidek laser outperformed
the other five lasers at the 20/16 level at 6 months. The Carl Zeiss/Meditec laser outperformed the other five at 6 months in terms of
refractive outcome ± 0.5 D. The Abbott and Alcon lasers outperformed the other four lasers in the safety category (least amount of >2 line
loss of best-corrected visual acuity [BCVA]) at the 1 month visit. There were no significant differences between the platforms, in the safety
category, at all other time intervals. Conclusion: At all times, all lasers fell within the FDA guidelines for safety regarding loss of best-
Keywords Myopia, LASIK, outcomes, safety, efficacy, phase IV, peer-reviewed
Disclosure: Christopher L Blanton, MD, is a consultant, and has received speaker fees and grant support from Abbott Medical Optics. He is a consultant for Allergan and has
received speaker fees.
Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and
reproduction provided the original author(s) and source are given appropriate credit.
Guidelines for Ethical Compliance: This article does not contain any studies with human or animal subjects performed by the author.
Received: January 15, 2015 Accepted: February 6, 2015 Citation: US Ophthalmic Review, 2015;8(1):23–9
Correspondence: Christopher L Blanton, MD, 9481 Haven Ave, Suite 200, Rancho Cucamonga, CA 91730, US. E: Blanton007@aol.com
Support: This study was sponsored by a grant from Abbott Medical Optics. Abbott Medical Optics had no role in study design, collection, analysis, or interpretation of the data, or
manuscript preparation. There were no publication charges associated with this manuscript.
Laser-assisted in situ keratomileusis (LASIK) for myopia is the most
commonly performed corneal refractive procedure performed in
the world today. The use of the excimer laser to reshape the
cornea is accomplished utilizing an ultraviolet laser that contains
sufficient energy per pulse to disrupt the organic bonds, which reside
in the cornea. This allows corneal stromal tissue to be removed in
very precise 0.25 micron increments enabling the surgeon to alter the
shape of the cornea. Excess energy is dissipated in acoustic and photic
forms. There are a number of excimer laser platforms available today
for use by surgeons when performing this procedure. Although there
have been sporadic articles comparing one or two laser platforms
to another, 1–4 and rarely an article comparing several of the most
commonly used excimer lasers, 5 there has not been a recent
comprehensive comparison of currently available platforms looking at
standard safety and efficacy data. This meta-analysis was undertaken
to accomplish that goal.
Tou ch MEd ica l MEdia
Methods An Internet-based search using SCOPUS, a system designed to screen
and filter journal articles, was conducted. SCOPUS is the largest abstract
and citation database of peer-reviewed research literature. The words
“myopia,” “LASIK,” and “outcomes” were used to filter the articles in
the categories of “article title,” “abstract,” and “keywords.” The time
period went from November 2013 retrospectively to January of 2007.
Articles older than this were considered to be anachronistic. Inclusion
criteria included the following: English-language, peer-reviewed journals
for the surgical procedure of myopic LASIK. In addition, the following
parameters were selected for inclusion: Snellen visual acuity at 1, 3,
6, and 12 months; efficacy regarding refractive error targeting: ± 0.5
diopters (D) at 3, 6, and 12 months; ± 1.0 D at 3, 6, and 12 months. Finally,
the adverse event—loss of best-corrected visual acuity (BCVA) (>2 lines)
at 1, 3, 6, and 12 months was also examined. Exclusion criteria were:
any studies on eyes with 1) prior eye surgery, 2) pathology, or 3) for an