1. A Comparison of Visual Acuity, Refractive Outcomes, and Satisfaction Between LASIK Performed with a Microkeratome and a Femto Laser
Nauman hashmani (MBBS), sharif hashmani (FCPS)
Hashmanis Hospital, pakistan

2. Financial Interests
There are no financial interests to note.

3. The World on the Modalities
Two meta-analysis have been conducted in 2012
Neither found better efficacy
However one found a better predictability in the FAL
One found fewer HOAs in the FAL arm
Both these incorporated low frequency high impulse lasers.
Some studies demonstrate a difference in recovery time as the primary difference, in terms of refractive outcomes and efficacy.
Another meta-analysis demonstrates differences in the various femto lasers used.

4. Methods
This was a retrospective study involving two arms: LASIK with a Hansatome microkeratome (HM) and LASIK with a femto laser (FAL)
687 patients (1366 eyes) were included
1137 eyes treated by HM
229 by FAL
Study period was from January 2013 to August 2016
Three different surgeons took part in the HM arm; 1 surgeon in FAL arm
All surgeries at the Hashmanis Hospital
Patients were followed up 1 month after the procedure to evaluate for:
Visual Acuity using the Snellen chart
Refraction using objective and subjective techniques

5. Results: Preoperative Measurements
We found no statistically significant difference in preoperative parameters.
Table 1: Preoperative Data
Variable
Hansatome Microkeratome (n=1137*)
Femto-Assisted Laser (n=229*)
P-value
Age (Years)
25.0 ± 5.8 (18.0 to 50.0)
27.0 ± 7.3 (18.0 to 52.0)
Gender, eyes (M/F)
474/663
72/157
Sphere (D)
-4.3 ± 2.8 (-19.0 to 7.0)
-4.3 ± 2.3 (-9.8 to 6.8)
0.656
Cylinder (D)
-1.0 ± 1.0 (-6.0 to 5.0)
-1.0 ± 1.3 (-12.8 to 3.3)
0.713
Spherical Equivalent (D)
-4.5 ± 2.8 (-19.5 to 8.0)
-4.5 ± 2.5 (-13.4 to 8.0)
0.977
* = Number of eyes Abbreviations: D, diopters; SE, Spherical Equivalent

6. Results: Postoperative Measurements
All postoperative outcomes were statistically significant.
Table 2: Postoperative Data
Variable
Hansatome Microkeratome (n=1137*)
Femto-Assisted Laser (n=229*)
P-value
Sphere (D)
0.0 ± 1.28 (-10.8 to 6.8)
0.3 ± 0.7 (-5.5 to 1.8)
<0.001
Cylinder (D)
-0.5 ± 0.5 (-4.5 to 1.5)
-0.5 ± 0.6 (-5.0 to 1.0)
Spherical Equivalent (D)
-0.3 ± 1.3 (-11.6 to 6.8)
0.0 ± 0.7 (-6.0 to 1.6)
Notes: * = Number of eyes
Abbreviations: D, diopters; SE, Spherical Equivalent 

7. Results: Efficacy (Visual Acuity)
We yielded a efficacy index of 1.00 for the FAL arm.
The HM arm yielded a lower 0.84 efficacy index.

8. Results: Astigmatism

9. Results: Predictability
Predictability index of the FAL arm: 92.1 percent
Predictability index of the HM arm: 82.2 percent

10. Results: Spherical Equivalent

11. Results: Patient Satisfaction
93.3 percent were satisfied with the FAL.
91.4 percent were satisfied with HM.

12. Limitations This was a retrospective analysis
We could not measure higher order aberrations (HOA)
We could not measure contrast sensitivity
We only had 1 month follow up

13. Conclusion
We found superior outcomes in the FAL arm in almost all areas.
Patients were satisfied more with the FAL arm despite its significantly higher cost.

14. Thank you for your attention