J Cataract Refract Surg 2003; 29:257–263

Michael Bueeler, MSE, Michael Mrochen, PhD, Theo Seiler, MD 

Purpose: To investigate the lateral alignment accuracy needed in wavefront-guided refractive surgery to improve the ocular optics to a desired level in a percentage of normally aberrated eyes.  

Setting: Department of Ophthalmology, University of Zurich, Zurich, Switzerland 

Methods: The effect of laterally misaligned ablations on the optical outcome was simulated using measured wavefront aberration patterns from 130 normal eyes. The calculations were done for 3.0 mm, 5.0 mm, and 7.0 mm pupils. The optical quality of the simulated correction was rated by means of the root-mean-square residual wavefront error.  

Results: To achieve the diffraction limit in 95% of the normal eyes with a 7.0 mm pupil, a lateral alignment accuracy of 0.07 mm or better was required. An accuracy of 0.2 mm was sufficient to reach the same goal with a 3.0 mm pupil.  

Conclusion: Procedures must be developed to ensure that the ablation is within a tolerance range based on each eye's original optical error. Rough centration based on the surgeon's judgment might not be accurate enough to achieve significantly improved optical quality in a high percentage of treated eyes.