ABSTRACT
One of the major attractions of laser subepithelial keratectomy (LASEK) surgery is the potential application of customized wavefront-guided treatments. At the time of this writing, custom LASEK in the United States is primarily an off-label application. The preliminary results have been encouraging. This chapter focuses on the history, principles, and methods of wavefront analysis and their applications for customized LASEK surgery to correct high-order aberrations. The benefits of custom LASEK depend not only on accurate wavefront measurements but also on the state of accommodation and pupil size. The benefits are reduced when the pupil is small. The benefit would be greatest in patients in whom the pupil is larger and in scotopic situations, such as night driving. It is not clear whether eyes of keratoconus patients or those with debilitating induced aberrations secondary to previous refractive surgery will benefit from high-order corrections using custom LASEK surgery.
