George O. Waring IV, MD, FACS’s, “Presbyopia’s Coming of Age” blog focuses on surgical and technological innovations in presbyopia correction. Waring is founder and medical director of Waring Vision Institute in Mt. Pleasant, South Carolina.

BLOG: Beyond 20/20 is the goal

It’s a wonderful time to be a corneal refractive surgeon as the technology that we depend on has never been better. There are now multiple laser vision correction platforms and options available, ranging from topography-guided LASIK to small incision lenticule extraction to high-definition wavefront-guided LASIK.

Results have become so good, in fact, that 20/20 is no longer the goal — it’s beyond 20/20. In our institute, we are looking for better than 20/20 outcomes and improvements in best corrected visual acuity, as well. That’s what truly motivates patients to rave about their experience and refer others for consultations.

More than 60% of eyes treated with iDesign WFG LASIK gained BCVA after surgery compared with their preoperative corrected vision.
Source: George O. Waring IV

In choosing a technology that could deliver better than 20/20 results, I found the data reported by Ed Manche, MD, and colleagues at Stanford to be very compelling. They found that more than 60% of eyes treated with iDesign (Johnson & Johnson Vision) wavefront-guided (WFG) LASIK gained BCVA after surgery compared with their preoperative corrected vision (Figure 1). In prospective contralateral eye studies utilizing several different laser platforms, Manche’s group reported that WFG LASIK more consistently delivers 20/12.5 and 20/16 or better visual outcomes than wavefront-optimized (WFO) LASIK.

Others have reported similar findings. Moussa et al also compared WFG and WFO outcomes. Four times more eyes in the WFG group achieved 20/12.5 or better vision (44% vs. 11%). And in a prospective study comparing WFG LASIK and SMILE results in low to moderate myopes, Khalifa et al found higher rates of 20/16 uncorrected visual acuity in the WFG group.

As we review results from published studies and large, prospective cohorts presented at conferences, it is important to compare not just 20/20 outcomes but also the better than 20/20 rates and lines of vision gained.


He L, et al. Am J Ophthalmol. 2014;doi:10.1016/j.ajo.2014.02.037.

Khalifa MA, et al. J Refract Surg. 2017;doi:10.3928/1081597X-20170222-01.

Manche EE, et al. Stanford iDesign WFG system LASIK versus WFO LASIK Study. Presented at: American Society of Cataract and Refractive Surgery meeting; April 13-17-2018; Washington.

Moussa S, et al. Eur J Ophthalmol. 2016;doi:10.5301/ejo.5000882.

Sáles CS, et al. Ophthalmology. 2013;doi:10.1016/j.ophtha.2013.05.010.

Disclosure: Waring reports he is a consultant for Johnson & Johnson Vision.