Standardization for reporting medical outcomes facilitates clinical study comparisons and has a fundamental role on research reproducibility. In this context, we present AstigMATIC, a free standalone application for automated standardized astigmatism vector analyses in corneal and intraocular refractive surgeries. AstigMATIC uses a simple graphical user interface (GUI) and allows the simultaneous display and analysis of astigmatism magnitude and axis. The software produces the four following standard graphs according to the standards of the Alpins Method; 1-Target-Induced Astigmatism Vector, 2-Surgically-Induced Astigmatism Vector, 3-Difference Vector and 4-Correction Index. Vector means with X and Y standard deviations are automatically calculated and displayed on the corresponding single-angle vector plots (0 to 180°). Data points are entered into a simplified GUI with no need for command line input. The standard graphs can be easily exported as high-resolution TIFF images for figures to use in production and presentations. AstigMATIC software enables the user to easily and efficiently analyze vectorial astigmatism outcomes using the standardized Alpins Method for post-surgical astigmatism. AstigMATIC and the demonstration datasets are available to download from http://www.lasikmd.com/media/astigmatic .

PURPOSE: To investigate whether topography-guided laser in situ keratomileusis (LASIK) with anterior corneal astigmatism measured on the WaveLight Contoura (Alcon Laboratories, Inc., Fort Worth, TX) leads to better refractive outcomes compared to treating on the clinically measured manifest refractive astigmatism axis in eyes with primary myopic astigmatism. METHODS: Retrospective analysis of 1,274 consecutive LASIK eyes treated on the topography-measured anterior corneal astigmatism axis compared to eyes treated on the conventional clinical manifest refractive astigmatism axis. RESULTS: In eyes with a small axis discrepancy between anterior corneal astigmatism and refractive astigmatism of 5° to 20°, there was no significant difference in efficacy index, refractive astigmatism accuracy, and most Alpins vector analysis parameters. Both treatment modalities achieved 20/20 uncorrected distance visual acuity (UDVA) in 90% of eyes, with 95% having postoperative cylinder of 0.50 diopters (D) or less. In eyes with a large axis discrepancy between 21° and 45° treated on the anterior corneal astigmatism axis, outcomes were both statistically and clinically inferior. Fewer eyes achieved UDVA of 20/20 (88.9% vs 73.6%; P = .01) and fewer had a defocus equivalent of 0.25 (65.6% vs 52.7%), 0.50 (86.9% vs 80.0%), and 0.75 (97.5% vs 90.9%) D or less ( P < .05 for all). Significantly more eyes achieved an angle of error greater than 15° (25.4% vs 8.1%; P = .004), had postoperative residual astigmatism of 0.75 D or less (18.2% vs 7.4%; P = .03), and needed an excimer laser re-treatment (11% vs 1.6%; P = .007). CONCLUSIONS: Topography-guided myopic astigmatism LASIK treated on the topography-measured anterior corneal astigmatism axis resulted in inferior refractive and visual outcomes compared to treating on the clinical manifest refractive astigmatism axis. [ J Refract Surg . 2019;35(1):15–23.]

Background: Standardization for reporting medical outcomes enables clinical study comparisons and has a fundamental role in research reproducibility. In this context, we present mEYEstro, a free novel standalone application for automated standardized refractive surgery graphs. mEYEstro can be used for single and multiple group comparisons in corneal and intraocular refractive surgery patients. In less than 30 s and with minimal user manipulation, mEYEstro automatically creates the required journal standard graphs while simultaneously performing valid statistical analyses. Results: The software produces the following 11 standard graphs; Efficacy: 1. Cumulative uncorrected (UDVA) and corrected visual acuity (CDVA), 2. Difference between UDVA and CDVA, Safety: 3. Change in line of CDVA, Accuracy: 4. Spherical equivalent (SEQ) to intended target, 5. Attempted vs. achieved SEQ, 6. Defocus equivalent (DEQ) accuracy, 7. Refractive astigmatism accuracy, 8. Target-induced astigmatism vs. Surgically-induced astigmatism, 9. Correction index histogram, 10. Angle of error histogram, Stability: 11. SEQ stability over time. Percent proportions, means, standard deviations, Cohen's d effect sizes, and p-values are calculated and displayed on each graph. All graphs can be easily exported as high-resolution TIFF images for figures to use in scientific manuscripts and presentations. Conclusions: mEYEstro software enables clinicians, surgeons, and researchers, to easily and efficiently analyze refractive surgery outcomes using the standardized methodology required by several peer-reviewed ophthalmology journals.

To describe the incidence, risk factors, and outcomes before and after irrigation of clinically significant laser in situ keratomileusis (LASIK) flap striae. Multisurgeon multicenter standardized protocol practice. Retrospective case-control series. Eyes with striae necessitating flap relift and irrigation were identified. Preoperative, intraoperative, and postoperative variables were collected. Incidence, risk factors, and outcomes were assessed. Of the 109 403 eyes that had LASIK, the incidence of striae-treated eyes was 0.79% (n = 875), with 8.7% irrigated the first hour after surgery. The preoperative spherical equivalent (SE) and ablation depth exponentially increased the striae risk (R2 = 0.9674; P < .001). Striae induced a small hyperopic shift that reversed after the relift (mean 0.22 diopter [D] ± 0.52 [SD] versus -0.02 ± 0.45 D) (P < .001). After relifting, 68.0%, 87.0%, and 96.0% of eyes had an uncorrected distance visual acuity (UDVA) of 20/20, 20/25, 20/40 or better versus 25.0%, 55.0%, and 84.0%, respectively, before the relift (P < .001). Thirteen percent fewer striae-treated eyes achieved a UDVA of 20/20. Before relifting, 51.0% of striae eyes lost 1 or more lines of corrected distance visual acuity, with a safety index reverting to control values (0.99 versus 1.00) (P > .05) after the relift. A laser refractive enhancement was performed in 6.28% of relifted striae eyes versus 3.04% in nonstriae control eyes. Flap striae requiring surgeon intervention occurred in 0.79% of eyes. Higher preoperative SE values were associated with an exponential increase risk for striae. Treatment by lifting and irrigation significantly improved the accuracy, efficacy, and safety to a level close to that of contralateral control eyes, although striae-treated eyes were more likely to need excimer laser retreatment.

PURPOSE: To characterize the preoperative vectorial difference between manifest refractive astigmatism and anterior corneal astigmatism, termed ocular residual astigmatism (ORA), and to investigate its influence on topography-guided laser in situ keratomileusis (LASIK) outcomes. METHODS: Comparative retrospective analysis of 21,581 consecutive eyes treated on the manifest refractive astigmatism. Standard outcomes of the 7,180 eyes with the lowest ORA (first tercile: 0.35 ± 0.13 diopters [D]) were compared to the 7,208 eyes with the highest ORA (last tercile: 1.13 ± 0.25 D). RESULTS: The ORA followed a right-skewed normal distribution ( R ² = 0.99) with a mean ± standard deviation of 0.73 ± 0.36 D. The efficacy index of eyes with low versus high ORA was identical (0.98 ± 0.07 vs 0.98 ± 0.08; P = .99), with a similar percentage having a spherical equivalent within ±0.50 D of the intended target (94.7% vs 94.1%; P = .11). The safety index (1.00 ± 0.04 vs 1.00 ± 0.04; P = .99) and Alpins correction index (1.01 ± 0.37 vs 1.00 ± 0.43; P = .10) were identical. A greater number of eyes with high versus low ORA had postoperative residual astigmatism of 0.75 D or greater (6.1% vs 3.9%). Eyes with very high ORA (ORA ⩾ 1.50 D; 2.5% of the population) marginally reduced the efficacy index from 0.98 to 0.97 ( P < .001). CONCLUSIONS: The contribution of ORA to topography-guided clinical outcomes in most virgin eyes is negligible, with excellent efficacy, accuracy, and safety in both low ORA and high ORA groups. Myopic eyes with high ORA treated on the manifest refraction should not be excluded from topography-guided LASIK. [ J Refract Surg . 2020;36(7):449–458.]