A patient from Camarillo recently asked me about topographical LASIK and how it compares to customized wavefront LASIK, also known as “wavefront guided” LASIK. The two versions of LASIK differ in how they take measurements of the eye. Topographical LASIK customizes the treatment to a map made of the outer surface of the cornea — the cornea’s “topography” Customized wavefront, by contrast, customizes the treatment to measurements taken by a laser beam traveling through the entire path of light through the eye. In other words, topographical LASIK customizes only to the surface whereas customized wavefront LASIK customizes to the entire eye, including the surface. A very recent study conducted in Japan and published in this month’s Journal of Cataract and Refractive Surgery compared customized wavefront LASIK using the VISX S4IR laser (which is the same laser I use in my practice) with topographical LASIK performed with the NIDEK laser. Both laser platforms produced excellent visual results, but objective measurements showed customized wavefront LASIK produced better contrast resolution (a measurement of visual quality) than the topographical LASIK system. The authors concluded, “the wavefront-guided ablation system may have some advantages in the quality of vision.” My own opinion after reviewing this and other studies is that customized wavefront LASIK remains the state of the art for the vast majority of patients having LASIK, but topographical LASIK technology is an important and exciting tool with some niche applications.