Abstract：Objective To investigate the clinical effect of reverse geometry design rigid gas permeable contact lenses (RGDRGPCLs) for improving postoperative visual quality in the patients who had undergone laser in situ keratomileusis (LASIK) and discuss reasons for the decline in visual quality. Methods In this prospective study， 20 patients (28 eyes) who wore RGDRGPCLs after LASIK surgery to improve defective visual quality were chosen during the period of 2010.01-2010.10. A Pentacam three-dimensional anterior segment analyzer and CGT-1000 contrast sensitivity measuring instrument were used to obtain corneal wavefront aberrations， contrast sensitivity and subjective symptoms in patients. Meanwhile， the corneal wavefront aberrations of 15 myopic patients (30 eyes) who were wearing spectacles were compared to those of the postoperative patients with and without RGDRGPCLs. SPSS 13.0 statistical software was used for an independent samples t test， paired samples t test and linear correlation analysis of the related data. Results Comparative root mean square （RMS） values of total aberration， total higher-order aberrration， spherical aberration and posterior corneal spherical aberrations for post-LASIK patients were significantly different when spectacle （t=-7.684， -5.658， -5.342， 4.039， P<0.05） and RGDRGPCL wearers were compared (t=4.510， 4.520， 3.826， -4.672， all P<0.05). No significant difference was found for coma (horizontal， vertical). Corneal anterior aberrations of postoperative patients were different from RGDRGPCL wearers （t=4.361， P<0.01）， but there was no significant change found when patients who wore RGDRGPCLs were compared to myopic patients. The total trefoil aberration between myopic and postoperative patients with （t=-7.464， P<0.01） or without RGDRGPCLs wear was statistically significant (t=-7.027， P<0.01)； however， no difference was found within the postoperative patient group. No difference between contrast sensitivity or glare contrast sensitivity was found among postoperative patients who wore either glasses or RGDRGPCLs. The best corrected visual acuity of postoperative patients wearing RGDRGPCLs negatively correlated to RMS value of corneal total aberration (r=-0.469， P=0.037). RGDRGPCL wear improved the patient satisfaction rate for visual quality as much as 95%. Conclusion Severe corneal higher-order aberrations caused by LASIK surgery is a major reason for the decline in visual quality. The values of total aberration， spherical aberration and others were reduced by wearing RGDRGPCLs， which can help to improve postoperative visual quality.
Oshika T， Miyata K， Tokunaga T， et al. Higher order wavefront aberrations of cornea and magnitude of refractive correction in laser in situ keratomileusis. Ophthalmology，2002，109：1154-1158.
[4]
Applegate RA，Hilmantel G，Howland HC，et al. Corneal first surface optical aberrations and visual performance. J Refract Surg，2000，16：507-514.
[5]
Marcos S， Barbero S， Llorente L， et al. Optical response to LASIK surgery for myopia from total and corneal aberration measurement. Invest Ophthalmol Vis Sci，2001，42：3349-3356.
[6]
Hiatt JA， Grant CN， Boxer Wachler BS， et al. Establishing analysis parameters for spherical aberration after wavefront LASIK. Ophthalmology，2005，112：998-1002.
[7]
Naroo SA， Charman WN. Changes in posterior corneal curvature after photorefractive keratectomy. J Cataract Refract Surg，2000， 26：872-878.
[8]
Seiler T， Mrochen M， Kaemmerer M. Operative correction of ocular aberrations to improve visual acuity. J Refract Surg，2000，16：s619-s622.
[9]
Marcos S， Barbero S， Llorente L， et al. Optical response to LASIK surgery for myopia from total and corneal aberration measurements. Invest Ophthalmol Vis Sci，2001，42：3349-3356.
[10]
Dorronsoro C， Barbero S， Llorente L， et al. On-eye measurement of optical performance of rigid gas permeable contact lenses based on ocular and corneal aberrometry. Optom Vis Sci，2003，80：115-125.
[11]
Marcos S. Refractive surgery and optical aberrations. Optics Photonics News，2001：22-25.
[12]
Wang L， Koch DD. Ocular higher-order aberrations in individuals screened for refractive surgery. J Cataract Refract Surg，2003， 29：1896-1903.
[13]
Wang Y， Zhao K， Jin Y， et al. Changes of higher order aberration with various pupil sizes in the myopia eyes. J Refract Surg，2003，19：S270-S274.
[14]
Chalita MR， Chavala S， Xu M，et al. Wavefront analysis in post-LASIK eyes and its correlation with visual symptoms， refraction， and topography. Ophthalmology，2004，111：447-453.
[15]
Marsack JD， Thibos LN， Applegate RA. Metrics of optical quality derived from wave aberrations predict visual performance. J Vis，2004，4：322-328.
[16]
Pesudovs K. Single-value metrics of wavefront aberration we there yet? J Refract Surg，2004，20：S493-S494.
[17]
Smolek MK， Klyce SD. Zernike polynomial fitting fails to represent all visually significant corneal aberrations. Invest Ophthalmol Vis Sci，2003，44：4676-4681.
Campbell FW， Green DG. Optical and retinal factors affecting visual resolution. J Physiol，1965，181：576-593.
[20]
Oshika T， Okamoto C， Samejima T， et al. Contrast sensitivity function and ocular higher-order wavefront aberrations in normal human eyes. Ophthalmology，2006，113：1807-1812.
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