Laser-assisted in-situ keratomileusis (LASIK) compared to photorefractive keratectomy (PRK) for correcting short-sightedness

Myopia is the term used to describe short or near-sightedness, which means that you cannot see objects in the distance clearly. Most people with myopia wear spectacles or contact lenses. Glasses can be uncomfortable and are not practical for sport; contact lenses can be associated with corneal infections. For these reasons, some people choose to have surgery for myopia. Two commonly used surgical techniques are LASIK and PRK. Both these procedures use laser to remove corneal tissue and reshape the cornea. This review analyses the results from 13 clinical trials where 1923 eyes of 1135 participants were randomly treated with either LASIK or PRK. We considered the overall quality of evidence from these studies to be low. There was some evidence that LASIK gives a faster visual recovery than PRK, and is a less painful technique, although visual results one year after surgery were comparable. Surgical techniques are improving all the time and further trials are needed to see whether LASIK and PRK, as currently practised, are equally safe.

Authors' conclusions: 

LASIK gives a faster visual recovery and is a less painful technique than PRK. The two techniques appear to give similar outcomes one year after surgery. Further trials using contemporary techniques are required to determine whether LASIK and PRK as currently practised are equally safe. Randomising eyes to treatment is an efficient design, but only if analysed properly. In future trials, more efforts could be made to mask the assessment of outcome.

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Background: 

Myopia (also known as short-sightedness or near-sightedness) is an ocular condition in which the refractive power of the eye is greater than is required, resulting in light from distant objects being focused in front of the retina instead of directly on it. The two most commonly used surgical techniques to permanently correct myopia are photorefractive keratectomy (PRK) and laser-assisted in-situ keratomileusis (LASIK).

Objectives: 

To compare the effectiveness and safety of LASIK and PRK for correction of myopia by examining post-treatment uncorrected visual acuity, refractive outcome, loss of best spectacle-corrected visual acuity, pain scores, flap complications in LASIK, subepithelial haze, adverse events, quality of life indices and higher order aberrations.

Search strategy: 

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 11), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to November 2012), EMBASE (January 1980 to November 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to November 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 15 November 2012. We also searched the reference lists of the studies and the Science Citation Index.

Selection criteria: 

We included randomised controlled trials comparing LASIK and PRK for the correction of any degree of myopia.

Data collection and analysis: 

Two authors independently assessed trial quality and extracted data. We summarised data using the odds ratio and mean difference. We combined odds ratios using a random-effects model after testing for heterogeneity.

Main results: 

We included 13 trials (1135 participants, 1923 eyes) in this review. Nine of these trials randomised eyes to treatment, two trials randomised people to treatment and treated both eyes, and two trials randomised people to treatment and treated one eye. None of the paired trials reported an appropriate paired analysis. We considered the overall quality of evidence to be low for most outcomes because of the risk of bias in the included trials. There was evidence that LASIK gives a faster visual recovery than PRK and is a less painful technique. Results at one year after surgery were comparable: most analyses favoured LASIK but they were not statistically significant.

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