摘要
Background:To retrospectively analyse strategies for adjusting refractive surgery plans with reference to the preoperative manifest refraction.Methods:We constructed seven nomograms based on the refractive outcomes(sphere,cylinder,axis[SCA])of 150 consecutive eyes treated with laser in situ keratomileusis for myopic astigmatism.We limited the initial data to the SCA of the manifest refraction.All nomograms were based on the strategy:if for x diopters(D)of attempted metric,y D is achieved;we can reverse this sentence and state for achieving y D of change in the metric,x D will be planned.The effects of the use of plus or minus astigmatism notation,spherical equivalent,sphere,principal meridians notation,cardinal and oblique astigmatism,and astigmatic axis were incorporated.Results:All nomograms detected subtle differences in the spherical component(p<0.0001).Nomograms 5 and 7(using power vectors)and 6(considering axis shifts)detected significant astigmatic differences(nomogram 5,p<0.001;nomogram 6,p<0.05;nomogram 7,p<0.005 for cardinal astigmatism,p=0.1 for oblique astigmatism).We observed mild clinically relevant differences(~0.5 D)in sphere or astigmatism among the nomograms;differences of~0.25 D in the proposals for sphere or cylinder were not uncommon.All nomograms suggested minor improvements versus actual observed outcomes,with no clinically relevant differences among them.Conclusions:All nomograms anticipated minor improvements versus actual observed outcomes without clinically relevant differences among them.The minimal uncertainties in determining the manifest refraction(~0.6 D)are the major limitation to improving the accuracy of refractive surgery nomograms.
