Wavefront excimer laser refractive surgery for adults with refractive errors

Shi-Ming Li; Meng-Tian Kang; Ning-Li Wang; Samuel A Abariga

doi:10.1002/14651858.CD012687.pub2

Cirugía refractiva con láser excimer de frente de onda en adultos con errores de refracción

Appendices

Appendix 1. CENTRAL search strategy

#1 MeSH descriptor: [Corneal Surgery, Laser] explode all trees
#2 keratectom* or keratomileusis
#3 LASIK or Lasek or PRK
#4 laser* near/3 refractive near/3 surg$*
#5 laser* near/3 epithel* near/3 surg*
#6 MeSH descriptor: [Lasers, Excimer] this term only
#7 excimer near/3 laser*
#8 small incision lenticule extraction
#9 SMILE
#10 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9
#11 MeSH descriptor: [Corneal Wavefront Aberration] this term only
#12 wavefront*
#13 (high* or low*) near/3 aberration*
#14 HOA
#15 Customvue or Allegretto Wave
#16c custom or conventional
#17#11 or #12 or #13 or #15 or #16
#18#10 and #17

Appendix 2. MEDLINE Ovid search strategy

1. randomized controlled trial.pt.
2. (randomized or randomised).ab,ti.
3. placebo.ab,ti.
4. dt.fs.
5. randomly.ab,ti.
6. trial.ab,ti.
7. (group or groups).ab,ti.
8. or/1‐7
9. exp animals/
10. exp humans/
11. 9 not (9 and 10)
12. 8 not 11
13. exp corneal surgery, laser/
14. keratectom$.tw.
15. keratomileusis.tw.
16. LAS?K.tw.
17. PRK.tw.
18. (laser$ adj3 refractive adj3 surg$).tw.
19. (laser$ adj3 epithel$ adj3 surg$).tw.
20. Lasers, Excimer/
21. (excimer adj3 laser$).tw.
22. small incision lenticule extraction.tw.
23. SMILE.tw.
24. or/13‐23
25. Corneal Wavefront Aberration/
26. wavefront$.tw.
27. ((high$ or low$) adj3 aberration$).tw.
28. HOA.tw.
29. (Customvue or Allegretto Wave).tw.
30. (custom or conventional).tw.
31. or/25‐30
32. 24 and 31
33. 12 and 32

The search filter for trials at the beginning of the MEDLINE strategy is from the published paper by Glanville 2006.

Appendix 3. Embase Ovid search strategy

1. exp randomized controlled trial/
2. exp randomization/
3. exp double blind procedure/
4. exp single blind procedure/
5. random$.tw.
6. or/1‐5
7. (animal or animal experiment).sh.
8. human.sh.
9. 7 and 8
10. 7 not 9
11. 6 not 10
12. exp clinical trial/
13. (clin$ adj3 trial$).tw.
14. ((singl$ or doubl$ or trebl$ or tripl$) adj3 (blind$ or mask$)).tw.
15. exp placebo/
16. placebo$.tw.
17. random$.tw.
18. exp experimental design/
19. exp crossover procedure/
20. exp control group/
21. exp latin square design/
22. or/12‐21
23. 22 not 10
24. 23 not 11
25. exp comparative study/
26. exp evaluation/
27. exp prospective study/
28. (control$ or prospectiv$ or volunteer$).tw.
29. or/25‐28
30. 29 not 10
31. 30 not (11 or 23)
32. 11 or 24 or 31
33. keratectomy/
34. photorefractive keratectomy/
35. keratomileusis/
36. laser epithelial keratomileusis/
37. keratectom$.tw.
38. keratomileusis.tw.
39. LAS?K.tw.
40. PRK.tw.
41. (laser$ adj3 refractive adj3 surg$).tw.
42. (laser$ adj3 epithel$ adj3 surg$).tw.
43. excimer laser/
44. (excimer adj3 laser$).tw.
45. small incision lenticule extraction.tw.
46. SMILE.tw.
47. or/33‐46
48. corneal wavefront aberration/
49. wavefront$.tw.
50. ((high$ or low$) adj3 aberration$).tw.
51. HOA.tw.
52. (Customvue or Allegretto Wave).tw.
53. (custom or conventional).tw.
54. or/48‐52
55. 47 and 54
56. 32 and 55

Appendix 4. LILACS search strategy

keratectomy OR keratomileusis OR LASIK OR LASEK OR PRK OR excimer OR lenticule extraction OR SMILE and wavefront OR aberration OR custom OR conventional OR Customvue OR Allegretto Wave

Appendix 5. ClinicalTrials.gov search strategy

(keratectomy OR keratomileusis OR LASIK OR LASEK OR PRK OR excimer OR lenticule extraction OR SMILE) AND (wavefront OR aberration OR custom OR conventional OR Customvue OR Allegretto Wave)

Appendix 6. WHO ICTRP search strategy

wavefront OR aberration OR custom OR conventional OR Customvue OR Allegretto Wave = Title AND keratectomy OR keratomileusis OR LASIK OR LASEK OR PRK OR excimer OR lenticule extraction OR SMILE = Intervention

Appendix 7. ISRCTN search strategy

(keratectomy OR keratomileusis OR LASIK OR LASEK OR PRK OR excimer OR "lenticule extraction" OR SMILE) AND (wavefront OR aberration OR custom OR conventional OR Customvue OR "Allegretto Wave")

Appendix 8. Data on study characteristics

Mandatory items		Optional items
Methods
Study design	· Parallel group RCTi.e. people randomized to treatment · Within‐person RCTi.e. eyes randomized to treatment · Cluster RCTi.e. communities randomized to treatment · Cross‐over RCT · Other, specify	Exclusions after randomization Losses to follow up Number randomized/analyzed How were missing data handled? e.g. available case analysis, imputation methods Reported power calculation (Y/N), if yes, sample size and power Unusual study design/issues
Eyes or Unit of randomization/ unit of analysis	· One eye included in study, specify how eye selected · Two eyes included in study, both eyes received same treatment, briefly specify how analyzed (best/worst/average/both and adjusted for within person correlation/both and not adjusted for within person correlation) and specify if mixture one eye and two eye · Two eyes included in study, eyes received different treatments,specify if correct pair‐matched analysis done
Participants
Country		Setting Ethnic group Equivalence of baseline characteristics (Y/N)
Total number of participants	This information should be collected for total study population recruited into the study. If these data are only reported for the people who were followed up only, please indicate.
Number (%) of men and women
Average age and age range
Inclusion criteria
Exclusion criteria
Interventions
Intervention (n= ) Comparator (n= ) *See MECIR 65 and 70*	· Number of people randomized to this group · Drug (or intervention) name · Dose · Frequency · Route of administration
Outcomes
Primary and secondary outcomes as defined in study reports *See MECIR R70*	List outcomes Adverse events reported (Y/N) Length of follow up and intervals at which outcomes assessed	Planned/actual length of follow up
Trial information	Clinical trial registration number

Figure 1

Study flow diagram.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 4

Forest plot of comparison: 1 Wavefront vs Conventional procedure, outcome: 1.1 Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment: 6 months.

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$Forest plot of comparison: 1 Wavefront vs Conventional procedure, outcome: 1.5 Proportion of eyes within ± 0.50 diopters (D) of target refraction: 6 months.$

Figure 5

Forest plot of comparison: 1 Wavefront vs Conventional procedure, outcome: 1.5 Proportion of eyes within ± 0.50 diopters (D) of target refraction: 6 months.

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$Forest plot of comparison: 1 Wavefront vs Conventional procedure, outcome: 1.7 Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months.$

Figure 6

Forest plot of comparison: 1 Wavefront vs Conventional procedure, outcome: 1.7 Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months.

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Analysis 1.1

Comparison 1: Wavefront vs Conventional procedure, Outcome 1: Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment: 6 months

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Analysis 1.2

Comparison 1: Wavefront vs Conventional procedure, Outcome 2: Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment:12 months

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Analysis 1.3

Comparison 1: Wavefront vs Conventional procedure, Outcome 3: Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment: 6 months

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Analysis 1.4

Comparison 1: Wavefront vs Conventional procedure, Outcome 4: Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment:12 months

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$Comparison 1: Wavefront vs Conventional procedure, Outcome 5: Proportion of eyes within ± 0.50 diopters (D) of target refraction: 6 months$

Analysis 1.5

Comparison 1: Wavefront vs Conventional procedure, Outcome 5: Proportion of eyes within ± 0.50 diopters (D) of target refraction: 6 months

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$Comparison 1: Wavefront vs Conventional procedure, Outcome 6: Proportion of eyes within ± 0.50 diopters (D) of target refraction: 12 months$

Analysis 1.6

Comparison 1: Wavefront vs Conventional procedure, Outcome 6: Proportion of eyes within ± 0.50 diopters (D) of target refraction: 12 months

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$Comparison 1: Wavefront vs Conventional procedure, Outcome 7: Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months$

Analysis 1.7

Comparison 1: Wavefront vs Conventional procedure, Outcome 7: Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months

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$Comparison 1: Wavefront vs Conventional procedure, Outcome 8: Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months$

Analysis 1.8

Comparison 1: Wavefront vs Conventional procedure, Outcome 8: Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months

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Analysis 1.9

Comparison 1: Wavefront vs Conventional procedure, Outcome 9: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 1 month

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Analysis 1.10

Comparison 1: Wavefront vs Conventional procedure, Outcome 10: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 3 months

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Analysis 1.11

Comparison 1: Wavefront vs Conventional procedure, Outcome 11: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 6 months

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Analysis 2.1

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 1: Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment: 6 months

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Analysis 2.2

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 2: Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment:12 months

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Analysis 2.3

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 3: Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment: 6 months

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Analysis 2.4

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 4: Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment:12 months.

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$Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 5: Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment: 6 months$

Analysis 2.5

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 5: Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment: 6 months

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$Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 6: Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment:12 months$

Analysis 2.6

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 6: Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment:12 months

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$Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 7: Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months.$

Analysis 2.7

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 7: Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months.

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$Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 8: Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months$

Analysis 2.8

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 8: Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months

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Analysis 2.9

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 9: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 1 month

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Analysis 2.10

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 10: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 3 months

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Analysis 2.11

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 11: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 6 months

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Analysis 2.12

Comparison 2: Wavefront‐optimized vs Wavefront‐guided, Outcome 12: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 12 months

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Analysis 3.1

Comparison 3: Wavefront‐guided LASIK vs Wavefront‐guided PRK, Outcome 1: Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment.

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Analysis 3.2

Comparison 3: Wavefront‐guided LASIK vs Wavefront‐guided PRK, Outcome 2: Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment.

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$Comparison 3: Wavefront‐guided LASIK vs Wavefront‐guided PRK, Outcome 3: Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment.$

Analysis 3.3

Comparison 3: Wavefront‐guided LASIK vs Wavefront‐guided PRK, Outcome 3: Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment.

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$Comparison 3: Wavefront‐guided LASIK vs Wavefront‐guided PRK, Outcome 4: Mean refractive error expressed as mean spherical equivalent post‐treatment.$

Analysis 3.4

Comparison 3: Wavefront‐guided LASIK vs Wavefront‐guided PRK, Outcome 4: Mean refractive error expressed as mean spherical equivalent post‐treatment.

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Analysis 3.5

Comparison 3: Wavefront‐guided LASIK vs Wavefront‐guided PRK, Outcome 5: Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor

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Summary of findings 1. Wavefront procedures compared to conventional procedures for adults with refractive errors

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Wavefront procedures compared to conventional procedures for adults with refractive errors
Participant or population: Adults with refractive errors Setting: Eye hospital Intervention: Wavefront procedures Comparison: Conventional procedures
Outcomes	Risk with conventional procedure	Risk with wavefront	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment:12 months ‐ Procedure: PRK	86 per 100	88 per 100 (74 to 100)	RR 1.03 (0.86 to 1.24)	70 (1 RCT)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment:12 months ‐ Procedure: LASIK	see comment	‐	‐	‐	‐	There are no data on LASIK for this outcome at 12 months
Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment:12 months ‐ Procedure PRK	6 per 100	5 per 100 (5 to 6)	RR 0.94 (0.81 to 1.09)	70 (1 RCT)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction: 12 months ‐ Procedure PRK	86 per 100	88 per 100 (74 to 100)	RR 1.03 (0.86 to 1.24)	70 (1 RCT)	⊕⊕⊝⊝ LOW ^{1 2}	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction: 12 months ‐ Procedure LASIK	see comment	‐	‐	‐	‐	There are no data on LASIK for this outcome at 12 months
Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months ‐ Procedure PRK	The mean refractive error expressed as mean spherical equivalent post‐treatment:12 months ‐ Procedure PRK was ‐0.114	MD 0.04 higher (0.11 lower to 0.18 higher)	‐	70 (1 RCT)	⊕⊝⊝⊝ Very LOW^a,b,c	‐
Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment‐procedure LASIK; Mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor; proportion of eyes with significant visual loss (loss of 2 or more lines from pretreatment BSCVA); proportion of eyes with optical side effects, such as glare and halo:12 months	see comment	‐	‐	‐	‐	There was no data on these outcomes at 12 months
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean Difference; RR: Risk ratio
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^aDowngraded forImprecision. ^bDowngraded for risk of bias. ^cDowngraded for inconsistency.

Summary of findings 1. Wavefront procedures compared to conventional procedures for adults with refractive errors

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Summary of findings 2. Wavefront‐optimized procedures compared to wavefront‐guided procedures for adults with refractive errors

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Wavefront‐optimized procedures compared to wavefront‐guided procedures for adults with refractive errors
Participant or population: Adults with refractive errors Setting: Eye hospital Intervention: Wavefront‐optimized Comparison: Wavefront‐guided procedure
Outcomes	Risk with Any wavefront‐guided procedure	Risk with Any wavefront‐optimized	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment:12 months ‐ overall estimate	97 per 100	97 per 100 (96 to 99)	RR 1.00 (0.99 to 1.02)	618 (5 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) post‐treatment:12 months ‐ overall estimate	5 per 100	5 per 100 (5 to 5)	RR 0.99 (0.96 to 1.02)	622 (5 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment:12 months ‐ overall estimate	91 per 100	93 per 100 (87 to 99)	RR 1.02 (0.95 to 1.09)	480 (4 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months ‐ Procedure PRK	The mean refractive error expressed as mean spherical equivalent post‐treatment:12 months ‐ Procedure PRK was −0.21 spherical equivalent	MD 0.07 spherical equivalent higher (0.03 lower to 0.18 higher)	‐	334 (2 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months ‐ Procedure LASIK	The mean refractive error expressed as mean spherical equivalent post‐treatment:12 months ‐ Procedure LASIK ranged from 0.26 spherical equivalent	MD 0.14 spherical equivalent lower (0.19 lower to 0.09 lower)	‐	472 (4 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor: 12 months ‐ overall estimate	The mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor: 12 months was 0.26	MD 0.03 higher (0.01 lower to 0.07 higher)	‐	622 (5 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes with significant visual loss (loss of 2 or more lines from pretreatment BSCVA): 12 months	see comment	‐	‐	‐	‐	One study that compared wavefront‐optimized LASIK versus wavefront‐guided LASIK reported on loss of 2 or more lines from pretreatment BSCVA that had not returned to baseline by 12 to 24 months after treatment (Manche 2013). Proportion of eyes with optical side effects, such as glare and halo
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean Difference; RR: Risk ratio
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^aDowngraded for risk of bias. ^bDowngraded for imprecision. ^cDowngraded for inconsistency.

Summary of findings 2. Wavefront‐optimized procedures compared to wavefront‐guided procedures for adults with refractive errors

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Summary of findings 3. Wavefront‐guided LASIK compared to wavefront‐guided PRK for adults with refractive errors

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Wavefront‐guided LASIK compared to wavefront‐guided PRK for adults with refractive errors
Participant or population: Adults with refractive errors Setting: Eye hospital Intervention: Wavefront‐guided LASIK Comparison: Wavefront‐guided PRK
Outcomes	Risk with wavefront‐guided PRK	Risk with wavefront‐guided LASIK	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment. ‐ 12 months	94 per 100	97 per 100 (87 to 100)	RR 1.03 (0.93 to 1.15)	66 (1 RCT)	⊕⊝⊝⊝ Very LOW^a,b	‐
Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment. ‐ 12 months	6 per 100	6 per 100 (6 to 7)	RR 1.03 (0.93 to 1.15)	66 (1 RCT)	⊕⊝⊝⊝ Very LOW^a,b	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment. ‐ 12 months	909 per 1,000	882 per 1,000 (745 to 1,000)	RR 0.97 (0.82 to 1.14)	66 (1 RCT)	⊕⊝⊝⊝ Very LOW^a,b	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment. ‐ 12 months	The mean refractive error expressed as mean spherical equivalent post‐treatment. ‐ 12 months was −0.17	MD 0.01 higher (0.18 lower to 0.2 higher)	‐	66 (1 RCT)	⊕⊝⊝⊝ Very LOW^a,b	‐
Mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor ‐ 12 months	The mean HOAs post‐treatment, measured by machine with wavefront sensor ‐ 12 months was 0.38	MD 0.01 lower (0.09 lower to 0.07 higher)	‐	66 (1 RCT)	⊕⊝⊝⊝ Very LOW^a,b	‐
Proportion of eyes with significant visual loss (loss of 2 or more lines from pretreatment BSCVA): 12 months	see comment	‐	‐	‐	‐	This outcome was not reported
Proportion of eyes with optical side effects, such as glare and halo: 12 months	see comment	‐	‐	‐	‐	This outcome was not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^aDowngraded for risk of bias. ^bDowngraded for serious imprecision (‐2).

Summary of findings 3. Wavefront‐guided LASIK compared to wavefront‐guided PRK for adults with refractive errors

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Table 1. Wavefront compared to conventional procedure for adults with refractive errors

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Wavefront compared to conventional procedure for adults with refractive errors
Participant or population: Adults with refractive errors Setting: Eye hospital Intervention: Wavefront procedure Comparison: Conventional procedure
Outcomes	Risk with Conventional procedure	Risk with Wavefront	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment: 6 months ‐ overall estimate	831 per 1000	831 per 1000 (798 to 856)	RR 1.00 (0.96 to 1.03)	470 (6 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) post‐treatment: 6 months ‐ overall estimate	200 per 1000	216 per 1000 (172 to 272)	RR 1.04 (0.93 to 1.17)	151 (3 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction: 6 months ‐ Procedure PRK	917 per 1000	816 per 1000 (715 to 926)	RR 0.89 (0.78 to 1.01)	192 (3 RCTs)	⊕⊝⊝⊝ VERY LOW^a,b,c	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction: 6 months ‐ Procedure LASIK	900 per 1000	999 per 1000 (765 to 1000)	RR 1.11 (0.85 to 1.44)	20 (1 RCT)	⊕⊝⊝⊝ VERY LOW^a,b,c	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months ‐ Procedure PRK	The mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months ‐ Procedure PRK was 0	MD 0.06 higher (0.09 lower to 0.21 higher)	‐	196 (3 RCTs)	⊕⊝⊝⊝ VERY LOW^a,b,c	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months ‐ Procedure LASIK	The mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months ‐ Procedure LASIK was 0	MD 0.11 higher (0.05 lower to 0.28 higher)	‐	428 (5 RCTs)	⊕⊝⊝⊝ VERY LOW^a,b	‐
Mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor: PRK procedure: 6 months	see comment	see comment	‐	116 (2 RCTs)	⊕⊝⊝⊝ VERY LOW^a,b,c	Two studies reported data on PRK. Due to substantial heterogeneity, we did not combine data in a meta‐analysis. Point estimates from Mastropasqua 2006 (MD = −0.21, 95% CI −0.26 to −0.16) suggest benefit in favor of wavefront‐guided PRK relative to conventional PRK (56 eyes of 56 participants). Estimates from Karimian 2010 (MD 0.17, 95% CI 0.02 to 0.32) favors conventional PRK (56 eyes, 28 participants). There were no data on LASIK for this outcome at 6 months
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean difference; RR: Risk ratio
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect 2.4.1
^aDowngraded for risk of bias. ^bDowngraded for imprecision. ^cDowngraded for inconsistency.

Table 1. Wavefront compared to conventional procedure for adults with refractive errors

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Table 2. Wavefront‐optimized compared to wavefront‐guided for adults with refractive errors

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Wavefront‐optimized compared to wavefront‐guided for adults with refractive errors
Participant or population: Adults with refractive errors Setting: Eye hospital Intervention: Wavefront‐optimized Comparison: Wavefront‐guided
Outcomes	Risk with Wavefront‐guided	Risk with Wavefront‐optimized	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment: 6 months	982 per 1000	982 per 1000 (962 to 1000)	RR 1.00 (0.98 to 1.02)	444 (5 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) post‐treatment: 6 months	54 per 1000	54 per 1000 (51 to 56)	RR 0.99 (0.94 to 1.04)	258 (4 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment: 6 months	938 per 1000	872 per 1000 (816 to 938)	RR 0.93 (0.87 to 1.00)	258 (4 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months. ‐ Procedure PRK	The mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months. ‐ Procedure PRK was 0	MD 0.09 higher (0.02 lower to 0.2 higher)	‐	138 (1 RCT)	⊕⊕⊕⊝ MODERATE^a	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months. ‐ Procedure LASIK	The mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months. ‐ Procedure LASIK was 0	MD 0.12 lower (0.19 lower to 0.05 lower)	‐	280 (3 RCTs)	⊕⊕⊕⊝ MODERATE^a	‐
Mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor: 6 months	The mean HOAs post‐treatment, measured by machine with wavefront sensor: 6 months was 0	MD 0.03 higher (0 to 0.06 higher)	‐	478 (5 RCTs)	⊕⊕⊝⊝ LOW^a,b	‐
Proportion of eyes with significant visual loss (loss of 2 or more lines from pretreatment BSCVA) and proportion of eyes with optical side effects, such as glare and halo: 6 months	see comment	‐	‐	‐	‐	These two outcomes were not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean Difference; RR: Risk ratio
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^aDowngraded for risk of bias. ^bDowngraded for imprecision.

Table 2. Wavefront‐optimized compared to wavefront‐guided for adults with refractive errors

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Table 3. Wavefront‐guided LASIK compared to wavefront‐guided PRK for adults with refractive errors

Outcomes	*Anticipated absolute effects^ (95% CI)**		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Wavefront‐guided LASIK compared to wavefront‐guided PRK for adults with refractive errors
Participant or population: Adults with refractive errors Setting: Eye hospital Intervention: Wavefront‐guided LASIK Comparison: Wavefront‐guided PRK
Outcomes	Risk with Wavefront‐guided PRK	Risk with Wavefront‐guided LASIK	Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment. ‐ 6 months	939 per 1000	968 per 1000 (874 to 1000)	RR 1.03 (0.93 to 1.15)	66 (1 RCT)	⊕⊝⊝⊝ VERY LOW	‐
Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment. ‐ 6 months	970 per 1000	970 per 1000 (892 to 1000)	RR 1.00 (0.92 to 1.09)	66 (1 RCT)	⊕⊝⊝⊝ VERY LOW^a,b	‐
Mean refractive error expressed as mean spherical equivalent post‐treatment. ‐ 6 months	The mean refractive error expressed as mean spherical equivalent post‐treatment. ‐ 6 months was 0	MD 0 (0.13 lower to 0.13 higher)	‐	66 (1 RCT)	⊕⊝⊝⊝ VERY LOW^a,b	‐
Mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor ‐ 6 months	The mean higher‐order aberrations (HOAs) post‐treatment, measured by machine with wavefront sensor ‐ 6 months was 0	MD 0.02 higher (0.05 lower to 0.09 higher)	‐	66 (1 RCT)	⊕⊝⊝⊝ VERY LOW^a,b	‐
Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment. ‐ 6 months	see comment	‐	‐	‐	‐	This outcome was not reported
Proportion of eyes with significant visual loss (loss of 2 or more lines from pretreatment BSCVA): 6 months	see comment	‐	‐	‐	‐	This outcome was not reported
Proportion of eyes with optical side effects, such as glare and halo: 6 months	see comment	‐	‐	‐	‐	This outcome was not reported
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean Difference; RR: Risk ratio
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect
^aDowngraded for risk of bias. ^bDowngraded for very serious imprecision (‐2).

Table 3. Wavefront‐guided LASIK compared to wavefront‐guided PRK for adults with refractive errors

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Comparison 1. Wavefront vs Conventional procedure

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1.1 Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment: 6 months Show forest plot	6	470	Risk Ratio (IV, Random, 95% CI)	1.00 [0.96, 1.03]

1.1.1 Procedure PRK	2	136	Risk Ratio (IV, Random, 95% CI)	0.95 [0.81, 1.12]
1.1.2 Procedure LASIK	4	334	Risk Ratio (IV, Random, 95% CI)	1.00 [0.96, 1.04]
1.2 Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment:12 months Show forest plot	1	70	Risk Ratio (IV, Random, 95% CI)	1.03 [0.86, 1.24]

1.2.1 Procedure: PRK	1	70	Risk Ratio (IV, Random, 95% CI)	1.03 [0.86, 1.24]
1.3 Proportion of eyes that had lost 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment: 6 months Show forest plot	3	151	Risk Ratio (IV, Random, 95% CI)	1.04 [0.93, 1.17]

1.3.1 Procedure PRK	1	80	Risk Ratio (IV, Random, 95% CI)	1.00 [0.93, 1.07]
1.3.2 Procedure LASIK	2	71	Risk Ratio (IV, Random, 95% CI)	1.11 [0.88, 1.40]
1.4 Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment:12 months Show forest plot	1	70	Risk Ratio (IV, Random, 95% CI)	0.94 [0.81, 1.09]

1.4.1 Procedure PRK	1	70	Risk Ratio (IV, Random, 95% CI)	0.94 [0.81, 1.09]
1.5 Proportion of eyes within ± 0.50 diopters (D) of target refraction: 6 months Show forest plot	4		Risk Ratio (IV, Random, 95% CI)	Subtotals only

1.5.1 Procedure PRK	3	192	Risk Ratio (IV, Random, 95% CI)	0.89 [0.78, 1.01]
1.5.2 Procedure LASIK	1	20	Risk Ratio (IV, Random, 95% CI)	1.11 [0.85, 1.44]
1.6 Proportion of eyes within ± 0.50 diopters (D) of target refraction: 12 months Show forest plot	1	70	Risk Ratio (IV, Random, 95% CI)	1.03 [0.86, 1.24]

1.6.1 Procedure PRK	1	70	Risk Ratio (IV, Random, 95% CI)	1.03 [0.86, 1.24]
1.7 Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months Show forest plot	8		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.7.1 Procedure PRK	3	196	Mean Difference (IV, Random, 95% CI)	0.06 [‐0.09, 0.21]
1.7.2 Procedure LASIK	5	428	Mean Difference (IV, Random, 95% CI)	0.11 [‐0.05, 0.28]
1.8 Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months Show forest plot	1	70	Mean Difference (IV, Random, 95% CI)	0.04 [‐0.11, 0.18]

1.8.1 Procedure PRK	1	70	Mean Difference (IV, Random, 95% CI)	0.04 [‐0.11, 0.18]
1.9 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 1 month Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.9.1 Procedure LASIK	2	68	Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.22, ‐0.03]
1.9.2 Procedure LASEK	1	80	Mean Difference (IV, Random, 95% CI)	‐0.31 [‐0.38, ‐0.23]
1.10 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 3 months Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.10.1 Procedure PRK: 3 month	1	132	Mean Difference (IV, Random, 95% CI)	‐0.04 [‐0.10, 0.02]
1.10.2 Procedure LASIK: 3 month	3	92	Mean Difference (IV, Random, 95% CI)	‐0.02 [‐0.04, 0.00]
1.10.3 Procedure LASEK	1	80	Mean Difference (IV, Random, 95% CI)	‐0.23 [‐0.26, ‐0.19]
1.11 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 6 months Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.11.1 Procedure PRK: 6 month	2		Mean Difference (IV, Random, 95% CI)	Totals not selected

Comparison 1. Wavefront vs Conventional procedure

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Comparison 2. Wavefront‐optimized vs Wavefront‐guided

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
2.1 Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment: 6 months Show forest plot	5	444	Risk Ratio (IV, Random, 95% CI)	1.00 [0.98, 1.02]

2.1.1 Procedure PRK	1	104	Risk Ratio (IV, Random, 95% CI)	0.94 [0.87, 1.02]
2.1.2 Procedure LASIK	4	340	Risk Ratio (IV, Random, 95% CI)	1.00 [0.98, 1.02]
2.2 Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment:12 months Show forest plot	5	618	Risk Ratio (IV, Random, 95% CI)	1.00 [0.99, 1.02]

2.2.1 Procedure PRK	2	334	Risk Ratio (IV, Random, 95% CI)	1.02 [0.98, 1.06]
2.2.2 Procedure LASIK	3	284	Risk Ratio (IV, Random, 95% CI)	1.00 [0.98, 1.02]
2.3 Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment: 6 months Show forest plot	4	258	Risk Ratio (IV, Random, 95% CI)	0.99 [0.94, 1.04]

2.3.1 Procedure PRK	1	104	Risk Ratio (IV, Random, 95% CI)	1.00 [0.95, 1.06]
2.3.2 Procedure LASIK	3	154	Risk Ratio (IV, Random, 95% CI)	0.96 [0.85, 1.08]
2.4 Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment:12 months. Show forest plot	5	622	Risk Ratio (IV, Random, 95% CI)	0.99 [0.96, 1.02]

2.4.1 Procedure PRK	2	334	Risk Ratio (IV, Random, 95% CI)	1.01 [0.97, 1.05]
2.4.2 Procedure LASIK	3	288	Risk Ratio (IV, Random, 95% CI)	0.97 [0.94, 1.01]
2.5 Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment: 6 months Show forest plot	4	258	Risk Ratio (IV, Random, 95% CI)	0.93 [0.87, 1.00]

2.5.1 Procedure PRK	1	104	Risk Ratio (IV, Random, 95% CI)	0.94 [0.86, 1.03]
2.5.2 Procedure LASIK	3	154	Risk Ratio (IV, Random, 95% CI)	0.92 [0.81, 1.04]
2.6 Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment:12 months Show forest plot	4	480	Risk Ratio (IV, Random, 95% CI)	1.02 [0.95, 1.09]

2.6.1 Procedure PRK	1	192	Risk Ratio (IV, Random, 95% CI)	1.06 [0.97, 1.15]
2.6.2 Procedure LASIK	3	288	Risk Ratio (IV, Random, 95% CI)	0.97 [0.86, 1.11]
2.7 Mean refractive error expressed as mean spherical equivalent post‐treatment: 6 months. Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.7.1 Procedure PRK	1	138	Mean Difference (IV, Random, 95% CI)	0.09 [‐0.02, 0.20]
2.7.2 Procedure LASIK	3	280	Mean Difference (IV, Random, 95% CI)	‐0.12 [‐0.19, ‐0.05]
2.8 Mean refractive error expressed as mean spherical equivalent post‐treatment:12 months Show forest plot	6		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.8.1 Procedure PRK	2	334	Mean Difference (IV, Random, 95% CI)	0.07 [‐0.03, 0.18]
2.8.2 Procedure LASIK	4	472	Mean Difference (IV, Random, 95% CI)	‐0.14 [‐0.19, ‐0.09]
2.9 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 1 month Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.9.1 Procedure PRK	1	140	Mean Difference (IV, Random, 95% CI)	0.03 [‐0.03, 0.09]
2.9.2 Procedure LASIK	3	296	Mean Difference (IV, Random, 95% CI)	0.03 [‐0.01, 0.07]
2.10 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 3 months Show forest plot	6		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.10.1 Procedure PRK	2	182	Mean Difference (IV, Random, 95% CI)	0.06 [0.01, 0.11]
2.10.2 Procedure LASIK	4	318	Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.06, 0.04]
2.11 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 6 months Show forest plot	5	478	Mean Difference (IV, Random, 95% CI)	0.03 [0.00, 0.06]

2.11.1 Procedure PRK	1	138	Mean Difference (IV, Random, 95% CI)	0.06 [‐0.01, 0.13]
2.11.2 Procedure LASIK	4	340	Mean Difference (IV, Random, 95% CI)	0.03 [‐0.01, 0.06]
2.12 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor: 12 months Show forest plot	5	622	Mean Difference (IV, Random, 95% CI)	0.03 [‐0.01, 0.07]

2.12.1 Procedure PRK	2	334	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.08, 0.13]
2.12.2 Procedure LASIK	3	288	Mean Difference (IV, Random, 95% CI)	0.03 [‐0.01, 0.06]

Comparison 2. Wavefront‐optimized vs Wavefront‐guided

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Comparison 3. Wavefront‐guided LASIK vs Wavefront‐guided PRK

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
3.1 Proportion of eyes with uncorrected visual acuity (UCVA) of 20/20 or better post‐treatment. Show forest plot	1		Risk Ratio (IV, Random, 95% CI)	Subtotals only

3.1.1 6 months	1	66	Risk Ratio (IV, Random, 95% CI)	1.03 [0.93, 1.15]
3.1.2 12 months	1	66	Risk Ratio (IV, Random, 95% CI)	1.03 [0.93, 1.15]
3.2 Proportion of eyes without loss of 1 or more lines of best spectacle‐corrected visual acuity (BSCVA) posttreatment. Show forest plot	1		Risk Ratio (IV, Random, 95% CI)	Subtotals only

3.2.1 12 months	1	66	Risk Ratio (IV, Random, 95% CI)	1.03 [0.93, 1.15]
3.3 Proportion of eyes within ± 0.50 diopters (D) of target refraction post‐treatment. Show forest plot	1		Risk Ratio (IV, Random, 95% CI)	Subtotals only

3.3.1 6 months	1	66	Risk Ratio (IV, Random, 95% CI)	1.00 [0.92, 1.09]
3.3.2 12 months	1	66	Risk Ratio (IV, Random, 95% CI)	0.97 [0.82, 1.14]
3.4 Mean refractive error expressed as mean spherical equivalent post‐treatment. Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.4.1 6 months	1	66	Mean Difference (IV, Random, 95% CI)	0.00 [‐0.13, 0.13]
3.4.2 12 months	1	66	Mean Difference (IV, Random, 95% CI)	0.01 [‐0.18, 0.20]
3.5 Mean higher‐order aberrations (HOAs) microns post‐treatment, measured by machine with wavefront sensor Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.5.1 1 month	1	66	Mean Difference (IV, Random, 95% CI)	‐0.06 [‐0.15, 0.03]
3.5.2 3 months	1	66	Mean Difference (IV, Random, 95% CI)	0.00 [‐0.07, 0.07]
3.5.3 6 months	1	66	Mean Difference (IV, Random, 95% CI)	0.02 [‐0.05, 0.09]
3.5.4 12 months	1	66	Mean Difference (IV, Random, 95% CI)	‐0.01 [‐0.09, 0.07]

Comparison 3. Wavefront‐guided LASIK vs Wavefront‐guided PRK

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Cirugía refractiva con láser excimer de frente de onda en adultos con errores de refracción

Appendices

Appendix 1. CENTRAL search strategy

Appendix 2. MEDLINE Ovid search strategy

Appendix 3. Embase Ovid search strategy

Appendix 4. LILACS search strategy

Appendix 5. ClinicalTrials.gov search strategy

Appendix 6. WHO ICTRP search strategy

Appendix 7. ISRCTN search strategy

Appendix 8. Data on study characteristics

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Appendices

Appendix 1. CENTRAL search strategy

Appendix 2. MEDLINE Ovid search strategy

Appendix 3. Embase Ovid search strategy

Appendix 4. LILACS search strategy

Appendix 5. ClinicalTrials.gov search strategy

Appendix 6. WHO ICTRP search strategy

Appendix 7. ISRCTN search strategy

Appendix 8. Data on study characteristics

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