Retinal nerve fiber layer measurements do not change after LASIK for high myopia as measured by scanning laser polarimetry with custom compensation

Purpose Scanning laser polarimetry (SLP) estimates retinal nerve fiber layer (RNFL) thickness through measurement of retardation of polarized light passing through the birefringent RNFL and cornea. A compensation method is incorporated to eliminate the anterior segment contribution to the total birefringence measured. LASIK is a technique that corrects myopia by ablating corneal tissue. This study evaluated RNFL measurements before and after LASIK as determined by SLP with a new custom compensation device set for the individual cornea before and after ablation. Design Interventional case series. Patients and methods Patients underwent SLP measurements before and 30 days after LASIK for high myopia with customized compensation for anterior segment birefringence. Postoperative measurements were obtained with both the same compensation as was used preoperatively and with newly determined customized compensation. Standard RNFL parameters obtained before and after ablation with customized compensation were compared by use of paired Student's t tests with Bonferroni's correction for multiple comparisons. Postoperative measurements were also compared with those obtained preoperatively with the same corneal compensation measures as used preoperatively. Main outcome measures Retinal nerve fiber layer parameters as determined by SLP before and after LASIK with 2 custom cornea compensator settings postoperatively. Results Fifty-seven eyes of 29 patients with myopia > −5.00 diopters underwent LASIK (average central ablation depth 101±11.3 μm). None of the 13 parameters showed statistically significant differences between preoperative and postoperative values with individually determined corneal compensation. When the preoperative corneal compensation was used postoperatively, 10 of 13 parameters were significantly changed. Comparison of the compensator settings before and after LASIK showed substantial differences in some individuals. On the average, there was a statistically significant change in the slow polarization axis of the cornea, with no statistically significant change in the magnitude of the birefringence, with some eyes showing increases and others decreases. The change in an individual cornea could not be predicted. Conclusions Changes in RNFL measurements by SLP observed after LASIK in patients with high myopia are due to changes in corneal birefringence. These RNFL changes are not seen when customized compensation is applied for the cornea. Thus, LASIK does change the corneal birefringence but does not affect the RNFL.