Ray-tracing LASIK with WaveLight Plus

Dr David Gunn at the WaveLight EX500 excimer laser at Focus Vision, Brisbane.

Introduction

Laser vision correction has improved steadily for more than 30 years, but until recently every excimer treatment was planned from one of two things: the glasses prescription or the shape of the front of the cornea. Ray tracing starts somewhere else. It builds a computer model of the individual eye, including both corneal surfaces, the lens and the axial length, and calculates the corneal shape that will focus light best in that eye.

WaveLight Plus (Alcon, Fort Worth, TX, USA), planned on the InnovEyes Sightmap diagnostic device, is the first commercially available ray-tracing laser treatment. The Sightmap received the CE mark in 2019,¹ and the US Food and Drug Administration (FDA) approved the treatment in March 2025.² In Australia it was first used in Sydney. We performed the first procedures in Queensland at Focus Vision in Brisbane in April 2024.

This article updates a review first published for optometrists in 2024.³ It covers how laser treatment profiles have evolved, how ray tracing works, the evidence published since then (including a randomised trial, the FDA trial and a meta-analysis), three-month results from our first 78 eyes, and practical guidance on selecting, preparing and co-managing patients.

Laser vision correction today

Laser refractive surgery changes the shape of the cornea to correct myopia, hyperopia and astigmatism, and with blended-vision approaches it can also help presbyopia. There are three families of procedure.

Surface ablation (PRK and transPRK)

In photorefractive keratectomy (PRK) the epithelium is removed and an excimer laser reshapes the anterior stroma directly. In transepithelial PRK (transPRK) the laser removes the epithelium as well. Each pulse removes, or ablates, a precise amount of tissue. There is no flap, so surface ablation suits thinner corneas, people who play contact sports and eyes with epithelial basement membrane disease. The trade-off is recovery: two to four uncomfortable days with a bandage contact lens, vision that keeps sharpening over several weeks, and a small risk of haze, which mitomycin C reduces.

LASIK

Laser in situ keratomileusis (LASIK) was first described in 1990.⁴ A thin corneal flap is lifted, the excimer laser treats the stroma underneath, and the flap is laid back down. Because the surface epithelium stays intact, recovery is quick and comfortable, and LASIK became the most commonly performed laser vision correction procedure in the world.⁵

Early flaps were cut with a microkeratome, an oscillating blade. Most are now made with a femtosecond laser, which creates a plane of tiny gas bubbles in the stroma (photodisruption) that the surgeon then separates with a blunt instrument. Femtosecond flaps are more predictable and have fewer flap-related complications than blade flaps.⁶

A patient positioned under the excimer laser, with the alignment beams centred on the eye.

Lenticule extraction (KLEx)

Lenticule extraction uses no excimer laser. A femtosecond laser cuts a thin lens-shaped piece of stroma, the lenticule, which the surgeon removes through a small incision. The first procedure, ReLEx, was introduced on the VisuMax femtosecond laser (Carl Zeiss Meditec, Germany) in 2007.⁷ Several companies now offer their own versions under trademarked names, including SMILE and SMILE pro (Carl Zeiss Meditec), CLEAR (Ziemer), SILK (Johnson & Johnson Vision) and SmartSight (Schwind).

The naming has been confusing. In 2023 a Refractive Surgery Alliance committee proposed laser-assisted lenticule extraction (LALEX) as an umbrella term.⁸ Later that year the two main refractive surgery journals published a joint editorial statement recommending keratorefractive lenticule extraction (KLEx),⁹ and KLEx is now the standard term, including in the 2025 evidence-based guidelines.¹⁰ This article uses KLEx, keeping a trademarked name where a study used a particular device.

Lenticule extraction avoids a flap and is widely used, particularly in Asia. Its treatment profiles are currently limited to sphere and cylinder, for reasons explained below.

How laser treatment profiles evolved

Each generation of excimer treatment has tried to fix a limitation of the one before. Table 1 summarises the sequence, and the sections that follow explain each step.

Table 1. Five generations of excimer treatment planning

Conventional treatments and the cosine effect

The first excimer treatments treated the cornea as a simple thin lens.¹¹ They removed a lens-shaped volume of tissue, calculated from the sphere and cylinder in the glasses prescription and applied to a standard model eye. This worked well for many patients, but it relied on the paraxial approximation: the assumption that light rays travel close to the optical axis at small angles. Real eyes do not behave that way in the periphery, particularly when the pupil is large.

Two problems followed. First, the treatments induced higher-order aberrations, especially positive spherical aberration, in which peripheral rays focus in front of central rays. Patients noticed this as haloes and reduced contrast in dim light.^{12, 13} Second, they ignored the cosine effect. A pulse that strikes the curved peripheral cornea at an angle spreads its energy over a larger area and removes less tissue than the same pulse at the centre, so the periphery was under-treated.

Wavefront-optimised treatments

Wavefront-optimised (WFO) profiles add pulses to the periphery to compensate for the cosine effect and limit the spherical aberration that the treatment itself would otherwise induce. Night vision improved. WFO profiles are still planned from the manifest refraction, though, and they do not reduce the higher-order aberrations the eye already has.¹³

Wavefront-guided treatments

Topographic irregularity is found in 10–40% of corneas with no ectatic disease.¹⁴ Wavefront-guided (WFG) treatments were the first attempt to treat these individual differences. An aberrometer, usually a Hartmann-Shack device, measures the wavefront of the whole eye, and the laser treats the higher-order aberrations it finds, such as coma, trefoil and spherical aberration, along with the sphere and cylinder.

In normal eyes the results were similar to, or slightly worse than, WFO treatment.¹⁵ WFG helped most in eyes with poor corrected vision or high aberrations before surgery, and it is now used mainly in that group.

Topography-guided treatments

Most of the eye's optical irregularity sits on the anterior corneal surface, which is also its most powerful refracting surface. Topography-guided (Topo-G) treatments use a detailed map of that surface to plan an ablation that regularises it. They are particularly useful in irregular corneas, including after previous corneal surgery.

Alcon's topography-guided treatment on the WaveLight excimer laser is called Contoura. In its FDA trial, 30% of eyes saw at least one line better without correction after surgery than they had with glasses or contact lenses before it.¹⁶ That trial used carefully selected eyes, with little corneal irregularity and close agreement between the astigmatism in the glasses prescription and the astigmatism on topography. It showed what customisation could do for eyes that already see well.

Making topography-guided treatment predictable

In routine practice the early results were less consistent, and refractive surprises were not rare. The reason is that higher-order and lower-order aberrations are linked. Change one and the others move: reducing coma changes the size and axis of the astigmatism, and changing spherical aberration shifts the sphere. When a topography-guided treatment removes a lot of corneal higher-order aberration, the sphere and cylinder the patient ends up with can differ from what was planned. Some surgeons returned to WFO. Those who persisted faced a planning question: how far should the treated sphere and cylinder be adjusted for what the topographer shows?

Several methods were developed to answer it. LYRA (Layer Yolked Reduction of Astigmatism) and TMR (topography-modified refraction) move the treated astigmatism towards the corneal measurement, and both improved outcomes compared with treating the manifest refraction.^{17, 18} The Phorcides Analytic Engine goes further. It combines the topography-guided treatment map, the anterior and posterior corneal curvature, the manifest refraction and a nomogram, and it predicted outcomes better than either manifest or TMR planning.¹⁹ In a prospective multicentre study of 130 eyes planned with Phorcides, all reached 6/6 (20/20) or better unaided at three months, 89% reached 6/4.5 (20/15) and 28% 6/3.8 (20/12.5); 40% gained one line of corrected acuity and 6% gained two.²⁰ Before ray tracing, Phorcides-planned Contoura was the profile used in more than 90% of LASIK treatments in our practice.

Why customised profiles need an excimer laser

Femtosecond lasers work by photodisruption: they create small cavitation bubbles inside the tissue. Excimer lasers work by photoablation: ultraviolet light breaks molecular bonds and removes tissue from the surface as a gas plume. Photoablation gives submicron control of tissue removal, which femtosecond lenticule cutting cannot yet match.²¹ As a result, nearly two decades after lenticule extraction was introduced, wavefront-guided, topography-guided, presbyopic and ray-tracing profiles are still delivered with an excimer laser.

The comparative evidence reflects this. In a randomised contralateral-eye study published in 2017, topography-guided LASIK gave better uncorrected acuity, more eyes gaining corrected acuity, less residual refractive error and better patient-reported results than SMILE.²² A second study found better early uncorrected vision and better contrast sensitivity in dim conditions with topography-guided LASIK.²³ In a review of the FDA premarket studies, 88.9% of topography-guided eyes reached 6/6 or better compared with 83.7% after SMILE, even though the topography-guided group had larger cylinder corrections.²⁴

Ray tracing has now been compared directly with KLEx. In a randomised contralateral-eye trial of 60 patients, so far reported only in conference abstracts, both eyes were treated using the ray-tracing refraction. At three months, 81.7% of WaveLight Plus eyes and 31.7% of SMILE pro eyes saw at least one line better unaided than their best-corrected acuity before surgery, and 100% and 76.7% respectively were within ±0.25 D of target.²⁵ A retrospective comparison published in 2026 also found better uncorrected acuity after WaveLight Plus than after SMILE pro, and less residual astigmatism than after either SMILE pro or WFO LASIK.²⁶ Until the randomised trial is published in full, these findings should be read with caution.

Lenticule extraction has its own advantages, not least the absence of a flap, and it remains a good choice for many patients. As femtosecond technology improves, customised profiles may follow on lenticule platforms.

How ray tracing works

Ray tracing is not new in optics. Physicists and computer-graphics designers use it to predict how light travels through a system of surfaces. In refractive surgery it means modelling the path of light through the patient's own eye: the front of the cornea, as in topography-guided treatment, but also the back of the cornea, the lens and the distance to the retina.

The WaveLight group first published a method for calculating corneal ablations by ray tracing through a personalised model eye in 2008.²⁷ Combining the necessary measurements in one diagnostic device, and automating the calculations, led to the CE mark for the Sightmap in 2019. The treatment was originally called InnovEyes and is now marketed as WaveLight Plus.

The Sightmap device

The Sightmap is a modified Pentacam AXL Wave (Oculus, Germany).¹ It combines three instruments, and all the measurements are taken in one sitting (Figures 1 and 2):

• a Hartmann-Shack aberrometer, which measures the wavefront of the whole eye
• a Scheimpflug tomographer, which maps the front and back surfaces of the cornea
• an optical biometer using laser interferometry, which measures the distances between the eye's refracting surfaces and the retina.

Figure 1: The InnovEyes Sightmap diagnostic device.

Figure 2: The three Sightmap measurements: whole-eye wavefront (Hartmann-Shack aberrometry), the front and back corneal surfaces (Scheimpflug tomography), and the exact position of each refracting surface (laser interferometry).

From measurements to a treatment

The software builds a model of the eye from these measurements, then calculates the treatment in four steps (Figure 3):²⁸

1. Build the model. Biometry measures the position of each refracting surface along the line of sight: corneal thickness, anterior chamber depth, the lens and the axial length. Every earlier profile assumed a standard (Gullstrand) emmetropic eye. This one uses the patient's own dimensions.
2. Trace from front to back. Tomography adds the front and back corneal surfaces, and about 2,000 rays are traced from the front of the cornea through the stroma and anterior chamber to the front surface of the lens.
3. Trace from back to front. The wavefront measurement is used to trace 2,000 rays in reverse, from the retina through the vitreous and the lens to the same lens surface.
4. Match the two. The software adjusts the modelled corneal shape, step by step, until the two sets of rays line up, allowing for tilt. That corneal shape becomes the ablation profile. A nomogram and a prediction of epithelial remodelling are built in.

Because sphere, cylinder and higher-order aberrations are calculated together inside the model, the coupling problem that made topography-guided planning difficult is handled by the calculation rather than by the surgeon's adjustments. The plan also needs fewer manual entries. Each manual step, such as typing a refraction or an axis, is a chance for a transcription error, so fewer steps is a safety gain as well as a time saving.

Figure 3: The four steps of ray-tracing treatment planning, from a personalised eye model to the final ablation profile. Adapted from Kanellopoulos.²⁸

Practical points

• WaveLight Plus is a LASIK treatment. It is delivered with the WaveLight EX500 excimer laser, and a femtosecond laser makes the flap.
• The Sightmap scans are taken in a darkened room so that the pupil is large enough for the wavefront measurement.
• Scan quality depends on a stable tear film. Dry eye and blepharitis need treating first, and some patients cannot produce scans of good enough quality; they are treated with another profile.
• The Sightmap measures the refraction objectively. If the patient accommodates during the scan, the measured refraction reads too myopic: in a series of 1,283 eyes it was more than 0.50 D more myopic than the manifest refraction in 21.4%. Options include repeating the scan, adjusting the plan, or scanning under cycloplegia.²⁹ An accurate manifest refraction is the check on the scan, and the US approval requires the two spherical equivalents to agree within 0.75 D.²
• The ray-tracing profile removes more tissue than other profiles. In a contralateral-eye study the mean ablation depth was 101 µm, compared with 85 µm for a Q-value-adjusted profile, with a slightly larger effective optical zone.³⁰ This matters for thinner corneas and higher prescriptions.
• In the US the treatment is approved for myopia with a spherical equivalent from more than 1.00 D up to 9.00 D, sphere up to 8.00 D and astigmatism up to 3.00 D, in patients aged 18 or over whose refraction has changed by 0.50 D or less over the previous year.²

Figure 4: A Sightmap scan at Focus Vision. The room is darkened so that the pupil is large enough for the wavefront measurement.

The published evidence

Early ray-tracing studies

The first multicentre European study predated the Sightmap: measurements from several separate devices were sent away for the treatment to be calculated. In 111 eyes with moderate to high myopic astigmatism, 83.8% reached 6/6 or better unaided at three months and 87.4% were within ±0.50 D of target.³¹ One-year results comparing ray tracing with WFO, WFG and topography-guided treatment on the same laser followed in 2013. No ray-tracing eye lost a line of corrected acuity, 38% gained one line and 10% gained more than one, and 9.5% reached 6/3.8 unaided, compared with none of the wavefront-guided eyes.³²

Results with the Sightmap

In 2020 Kanellopoulos reported the first eyes treated with the automated Sightmap system. All 40 eyes analysed reached 6/6 unaided, 65% gained at least one line of corrected acuity and 38% gained two, and contrast sensitivity improved.²⁸ The results were maintained at two years, with better contrast sensitivity and quality-of-vision questionnaire scores than before surgery.¹

In Sydney, He and Bala reported 400 eyes in 2023. At three months 100% reached 6/6 or better unaided, 89% 6/5, 51% 6/3.8 and 8% 6/3, and 39% saw at least one line better unaided than their best-corrected acuity before surgery.³³ An international post-market study of 212 eyes reported 98.1% at 6/6 or better, 82.5% at 6/5 or better and 35.8% gaining at least one line of corrected acuity, with 99.1% of patients satisfied.³⁴

Randomised, FDA and larger studies, 2024–2026

The first randomised comparison in a peer-reviewed journal came from Heidelberg in 2025. Thirty patients had ray-tracing LASIK in one eye and WFO LASIK in the other, with patients and examiners masked to the treatment. At three months, 100% of ray-tracing eyes and 90% of WFO eyes were within ±0.50 D of target, and the mean residual spherical equivalent was closer to zero (−0.05 D vs −0.16 D). Unaided acuity of 6/6 or better was reached by 100% and 93.3% of eyes, and 6/5 or better by 83.3% and 73.3%. Mean uncorrected and corrected acuities did not differ significantly, and higher-order aberrations at a 6 mm pupil were lower after ray tracing.³⁵

The US FDA trial treated 336 eyes of 168 patients at nine sites.^{2, 36} At 12 months, 94.4% of eyes saw 6/6 or better unaided and about 70% 6/5 or better; 26.7% had gained one or more lines of corrected acuity, and 14.0% saw at least one line better unaided than their best-corrected acuity before surgery. Glare, haloes and starbursts all became less common than before surgery (haloes fell from 55.1% to 23.9% of patients), and 98% of patients were very or completely satisfied.

These multicentre results are lower than the early single-centre series, and a comparison of the two FDA datasets puts them in context. Against the topography-guided (Contoura) FDA trial, ray tracing gave similar rates of 6/6 and 6/5 unaided vision at 12 months. The topography-guided eyes more often reached 6/3.8 and 6/3, and more often saw better unaided than their corrected acuity before surgery (30.9% vs 14.0%). Ray tracing produced larger gains in mesopic contrast sensitivity with glare, and it overcorrected moderate astigmatism (1 to 4 D) by 11–13%.³⁷ The two trials were run years apart in different patients, so the comparison is indirect.

Larger and longer series have since been published. A prospective study of 800 eyes reported, at one year, 100% at 6/6 or better unaided, 68% at 6/5, 96.5% within ±0.50 D and residual cylinder of 0.50 D or less in 95.2%.³⁸ A retrospective series of 101 eyes reported 100% at 6/6, 69% at 6/5 and 61% gaining corrected acuity, with 98% of patients satisfied.³⁹ A 2026 meta-analysis of 14 studies (1,577 eyes, median follow-up three months) found pooled rates of 99.2% for 6/6 or better unaided and 95.2% within ±0.50 D, with 2.2% of eyes losing one or more lines of corrected acuity.⁴⁰ On the same Sightmap platform, ray tracing gave better uncorrected acuity than topography-guided LASIK in one 2024 study,⁴¹ and more eyes gaining corrected acuity than a Q-value-adjusted profile (47% vs 32%) in another.³⁰

Taken together, ray tracing reliably delivers 6/6 or better unaided vision with high refractive accuracy. The proportion of eyes reaching 6/5 ranges from 68% to 89%, with the early single-centre series at the top of that range. Whether ray tracing gives better quality of vision than a well-planned topography-guided treatment is not settled: the contrast sensitivity data favour ray tracing, while the indirect FDA comparison found that topography-guided eyes more often reached better-than-normal acuity. Table 2 summarises the main series.

Table 2. Selected outcomes of ray-tracing LASIK (WaveLight Plus)

UDVA, uncorrected distance visual acuity; MRSE, manifest refraction spherical equivalent; WFO, wavefront-optimised; –, not reported or not available.

Our first 78 eyes in Brisbane

We introduced WaveLight Plus at Focus Vision in April 2024. One week after surgery, three of the first 16 eyes saw 6/3 unaided, something we had not seen with topography-guided treatment. One patient said: "It's weird, but I think I can see better now than I could before in my glasses."

We have since analysed 78 eyes treated for myopia or myopic astigmatism with a plano target, with three months of follow-up. These results were presented at the FOCUS 2026 meeting in Melbourne. Attempted spherical equivalent corrections ranged from 0.63 D to 6.63 D of myopia, and no nomogram adjustment was applied. At three months (Figures 5 to 7):

• Uncorrected vision. 100% of eyes reached 6/6 or better, 75.6% 6/5 or better, 17.9% 6/3.8 or better and 3.8% 6/3.
• Efficacy. 80.7% of eyes saw at least as well unaided as they had with their best correction before surgery, and 24.3% saw at least one line better. The efficacy index (mean postoperative uncorrected acuity divided by mean preoperative corrected acuity) was 1.03.
• Safety. No eye lost two or more lines of corrected acuity and 3.8% lost one line; 33.7% gained one or more lines. The safety index (mean postoperative corrected acuity divided by mean preoperative corrected acuity) was 1.05.
• Accuracy. 98.8% of eyes were within ±0.50 D of the target spherical equivalent and 100% within ±1.00 D; 46.2% were within ±0.13 D.
• Astigmatism. Refractive cylinder was 0.50 D or less in 92.4% of eyes after surgery, compared with 42.4% before; 69.6% of eyes were within 5° of the intended axis.

Figure 5: Cumulative uncorrected acuity three months after WaveLight Plus (dark bars) compared with best-corrected acuity before surgery (light bars), 78 eyes, Focus Vision, Brisbane.

Figure 6: Change in lines of best-corrected acuity at three months, 78 eyes. No eye lost two or more lines; a third gained at least one.

Figure 7: Spherical equivalent refraction at three months, 78 eyes targeted for plano. Most residual error fell on the slightly hyperopic side.

There was a slight hyperopic tendency: 33.4% of eyes were between +0.14 D and +1.00 D, and the regression slope of achieved against attempted correction was 1.03. We treated the calculated plan without adjusting it, accepting the Sightmap wavefront refraction (4 mm zone) when it agreed with the manifest spherical equivalent within 0.50 D. Larger series have reported the same tendency to overcorrect, particularly cylinder,^{30, 37, 39} and accommodation during the scan is one likely contributor.²⁹ A 10% reduction in the treated cylinder is now recommended. Understanding how the wavefront-derived refraction differs from a subjective refraction is the next step in refining results.

These outcomes sit within the range of the published series (Table 2). They are retrospective, three-month results from one practice and have not been peer reviewed, so they are a check on real-world performance rather than new evidence. In our practice every femtosecond LASIK candidate who can produce good-quality scans is now offered WaveLight Plus, and the comment we hear most often is a version of "I see better now than I ever did in contacts or glasses."

Figure 8: The Focus Vision team after the first WaveLight Plus procedures in Queensland, April 2024.

In the consulting room

Who is suitable

The basic requirements are the same as for any LASIK: an adult with a stable prescription in the treatable range, a healthy cornea on tomography with enough thickness, a healthy ocular surface and realistic expectations. Ray tracing adds two practical requirements: scans of good quality, and enough corneal tissue for a profile that removes a little more than other treatments.

When laser is not the right answer, the conversation moves to a different procedure rather than a different laser:

• thin corneas, contact sports or epithelial basement membrane disease: PRK
• high myopia, or myopia with thin corneas, in younger patients: an implantable collamer lens (ICL)
• presbyopic age or early lens change: refractive lens exchange or refractive cataract surgery
• suspicious or abnormal tomography: a corneal review for keratoconus, not laser.

Preparing a patient for assessment

• Document two stable refractions at least 12 months apart, with a change of 0.50 D or less.
• Ask patients to leave soft contact lenses out for one week before the assessment, and toric soft or rigid lenses for two to four weeks.
• Send an accurate manifest refraction, any topography and the refraction history with the referral. The manifest refraction is the check on the Sightmap's objective measurement.
• Treat dry eye and blepharitis first. The Sightmap measurements, the treatment plan and the result all depend on a stable tear film.

Setting expectations

The aim is unaided vision of 6/6 or better, which almost every eye reaches in the published series, and between two-thirds and nine-tenths of eyes reach 6/5. A quarter to a half of eyes gain a line of corrected acuity, and 14% to 39% see at least a line better unaided than they did with glasses before surgery. Those are population results, not a promise to an individual, and patients should hear them that way. Ray tracing does not treat presbyopia, and patients in their forties need to know that reading glasses are still ahead of them unless monovision is planned.

Recovery and co-management

A typical course after WaveLight Plus LASIK:

• Day 1. Gritty and watery for a few hours after surgery, with vision usually good by the next morning. The surgical team checks acuity and flap position.
• Week 1. The surgical team checks acuity and the flap interface for diffuse lamellar keratitis (DLK) or striae. The antibiotic drop stops and the steroid finishes. Most patients drive and return to work within one to two days of surgery.
• Month 3. Usually the last visit with the surgical team. The refraction has stabilised and is effectively the result.
• Months 6 to 12. Follow-up with the community optometrist: preservative-free lubricants (usually for about three months) and lid care for dry eye, then routine eye examinations.

Table 3. When to refer back to the surgeon

Limitations and open questions

• The treatment is approved only for myopia and myopic astigmatism. There are no published ray-tracing results for hyperopia.
• Total higher-order aberrations still rise slightly after ray tracing (pooled increase 0.09 µm), although they were lower than after WFO treatment in the randomised comparison.^{35, 40}
• The profile removes more tissue than WFO or topography-guided profiles.
• It needs good-quality scans in a darkened room, and some patients cannot provide them.
• It needs a specific platform, the Sightmap and the EX500 excimer laser, so it is available only in centres that have both.
• Most published series report three months of follow-up, none extends beyond two years, and the randomised trials are small. Many investigators, including the author, have financial relationships with the manufacturer. Larger independent and longer-term studies are needed, including direct comparisons with topography-guided treatment planned with modern tools.

Conclusion

Ray tracing moves the starting point of LASIK planning from the glasses prescription or the corneal surface to a model of the whole eye. Published case series, a randomised contralateral-eye trial, the FDA trial and a 2026 meta-analysis show that almost every eye reaches 6/6 unaided, with high refractive accuracy, and our first 78 eyes in Brisbane sit within that range. Whether ray tracing outperforms a well-planned topography-guided treatment is not yet settled. For optometrists the practical steps are the same as for any laser referral: send patients with stable refractions and a healthy ocular surface, set realistic expectations, and know which postoperative findings need a same-day call.

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Disclosures. Dr Gunn has financial relationships with Alcon (consultant, investigator, speaker), Azura Ophthalmics (investigator), Cylite (investigator), Glaukos (investigator), Johnson & Johnson (investigator) and Rayner (consultant, investigator, speaker). The relationship with Alcon, the manufacturer of WaveLight Plus, is relevant to this article.

This article updates and expands one first published in mivision in September 2024.³