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To examine possible differences in efficacy and safety between LASIK and photorefractive keratectomy (PRK) for correction of myopia.
Meta-analysis/systematic review.
Patient data from previously reported prospective randomized controlled trials (PRCTs) and a systematic review of prospective case series in the Food and Drug Administration (FDA) clinical trials database.
A comprehensive literature search was performed using the Cochrane Collaboration methodology to identify PRCTs comparing LASIK and PRK for correction of myopia. A meta-analysis was performed on the results of PRCTs. In parallel, a systematic review of prospective data from FDA case series of LASIK and PRK for correction of myopia was undertaken.
Key efficacy outcomes (uncorrected visual acuity [UCVA] ≥ 20/20, ±0.50 diopters [D] of the target mean refractive spherical equivalent) and safety outcomes (loss of ≥2 lines of best spectacle-corrected visual acuity [BSCVA], final BSCVA ≥ 20/40, and final BSCVA < 20/25 where preoperative BSCVA was ≥20/20).
Seven PRCTs were identified comparing PRK (683 eyes) and LASIK (403 eyes) for correction of myopia. More LASIK patients achieved UCVA ≥ 20/20 at 6 months (odds ratio, random effects model [95% confidence interval], 1.72 [1.14–2.58];
P = 0.009) and 12 months (1.78 [1.15–2.75],
P = 0.01). Loss of ≥2 lines of BSCVA at 6 months was less frequent with LASIK (2.69 [1.01–7.18],
P = 0.05). Data from 14 LASIK (7810 eyes) and 10 PRK (4414 eyes) FDA laser approval case series showed that more LASIK patients achieved UCVA of 20/20 or better at 12 months (1.15 [1.03–1.29],
P = 0.01), significantly more LASIK patients were within ±0.50 D of target refraction at 6 months (1.38 [1.26–1.50],
P<0.00001) and 12 months (1.21 [1.08–1.36],
P = 0.0009) after treatment, and loss of ≥2 lines of BSCVA at 6 months was less frequent with LASIK (2.91 [2.22–3.83],
P<0.00001).
LASIK appears to have efficacy and safety superior to those of PRK. However, the data examined are from studies conducted ≥5 years ago. It is therefore unclear how our findings relate to present-day methods and outcomes. Further trials comparing contemporary equipment and techniques are needed to reevaluate the relative merits of these procedures.