There is a lot of discussion regarding Wavefront Technology amongst LASIK websites. Most doctors will also charge you more for Wavefront Customized LASIK. So it is important for patients to understand what wavefront technology is, where it is useful, and what its limitations are.

When you go to an eye doctor or optician, they will give you a prescription for spectacles, typically specifying the sphere and cylindrical refractive error, along with the axis of the cylinder. Most people assume that that is the entire refractive error of the eye.

But in fact, the sphere and cylinder are only the lower order refractive errors (or the lower order optical aberrations of the optical system of the eye).  Certain higher order aberrations (which go by esoteric names as coma, trefoil, and spherical aberration) also exist in the optical system of the eye. These cannot be measured easily. An instrument, called a wavefront aberrrometer, is used to measure these.

Higher order aberrations cause very fine and small degradations in the optical quality. Their values are pupil size dependent. Higher order aberrations are generally small in value when the pupil size is small (as in good light), and have a higher value when the pupil size is large (as in dim light or in the dark). Therefore higher order aberrations generally cause more difficulty in night vision than during the day.

Recently (i.e. in the last 5-7 years), methods have developed which allow excimer lasers to treat higher order aberrations of the eye. Before the year 2000, wavefront aberrometers were not easily available instruments (they were too big, too complex and too expensive to work outside a typical research setting). Now they are available rather easily. Wavefront aberrometers give a unique set of aberrations for each patient (both the lower order-i.e. the sphere and cylinder as well as the higher order aberrations). When data from the wavefront aberrometer is used to generate a treatment pattern by the excimer laser, this is known as wavefront customized LASIK.

What is the promise of wavefront customized LASIK? Why should a patient undergo wavefront customized LASIK? Well, for starters, wavefront customized LASIK could improve night vision in some patients, who have high higher order aberrations. They could improve contrast sensitivity and give you a better vision in dull or dim light. Finally, in some patients, they could improve vision overall. This makes the technique of wavefront customized LASIK interesting for both eye surgeons and patients.

So as a patient, should you always opt for wavefront customized LASIK, if you can afford it? Well, the answer to that question is complex. A simple answer (which does not say much!!) is “It Depends”. If you have large pupils, and the doctor measures high values for the higher order aberrations, and you do a lot of night driving and other activities in dull or dim light, then undergoing wavefront customized LASIK is appropriate and important.

However, there are also good reasons, especially in an Indian context, not to always undergo wavefront customized LASIK. See our post  ”Should you always undergo wavefront customized LASIK?” for more details about why it is not always necessary to undergo wavefront customized LASIK. However, as that post elaborates, as far as possible, you should undergo aspheric LASIK or Q-Value Adjusted LASIK or Aberration Smart LASIK, even if you don’t (or sometimes should not) under wavefront customized LASIK.

What technology should you undergo wavefront customized LASIK? There are several trade names which, essentially, refer to the same thing, even if doctors tend to sell the particular one from the laser they own. These names include Zyoptix (Technolas), CustomVue (AMO/VisX), WASCA (Carl Zeiss) , C-LASIK (Nidek), and so on. All these names refer essentially to Wavefront Customized LASIK.

In our opinion, given the specifications of the laser and the aberrometer, and the number of years experience of the company with wavefront technology, platforms which should give you the best results include the Wavelight Allegretto Eye-Q, Carl Zeiss Meditec MEL 80 with WASCA and CRS-Master, and the Schwind Amaris.