By Dr. David Folden, MD | Twin Cities Eye Consultants
As a refractive surgeon performing LASIK in the Twin Cities for many years, patients often ask what technology we use and whether the newest technology is always the best. At TCEC, we actively evaluate and integrate new technology into our practice. But as in all areas of medicine, newer does not automatically mean better. New treatments should be judged by their clinical data, outcomes, and long-term performance—not simply by the excitement or marketing surrounding them.
LASIK continues to evolve, and that is a good thing. Advances in imaging, treatment planning, and laser technology continue to give refractive surgeons more information, greater precision, and more options than ever before.
Some new technologies clearly improve the way we evaluate or treat patients. Others are promising but need time—and reliable clinical data—to demonstrate that they are on par with, or perhaps improve upon, results with existing gold-standard technology.
At Twin Cities Eye Consultants (TCEC), we choose technology that we believe is most likely to produce the best and most predictable result for each eye of every patient.
Flap Creation: Precise and Customizable
At Twin Cities Eye Consultants, we create the corneal flap—the first step of LASIK—using the Ziemer Z4 femtosecond laser. The Z4 allows us to customize flap dimensions and edge architecture rather than applying exactly the same configuration to every eye.
Published data from Ziemer’s FEMTO LDV platform have demonstrated highly reproducible flap creation.¹
That predictability matters. Before the refractive (vision correcting) portion of LASIK even begins, we want a smooth, consistent, well-formed flap that provides a reliable foundation for the treatment that follows.
Wavefront-Optimized (WFO) LASIK: Our Foundation—and Why It Has Held Up
The second part of LASIK is the true vision correction that comes with the reshaping of the cornea using the excimer laser. For the majority of our patients, we continue to favor wavefront-optimized (WFO) LASIK technology.
WFO is designed to improve upon older conventional LASIK ablation profiles and reduce the induction of unwanted optical aberrations during corneal reshaping. This helps ensure good crisp visual acuity outcomes.
Most importantly, WFO has produced an exceptionally strong and reproducible clinical track record.
Prospective WFO studies have reported 20/20-or-better uncorrected vision in approximately 93% to 97% of treated eyes.²,³
More recently, a 2025 well-designed rigorous randomized study reported 93.3% of WFO-treated eyes achieving 20/20 or better and 73.3% achieving 20/16 or better.⁴
No single study defines what every individual patient should expect, and outcomes from different studies should not be treated as head-to-head comparisons. But when studies performed over many years repeatedly demonstrate 20/20-or-better vision in well over 90% of appropriately selected patients, that consistency matters.
I still consider WFO the gold-standard foundation against which newer technologies need to prove themselves.
What About Topography-Guided LASIK?
Topography-guided LASIK incorporates detailed measurements of the corneal surface into the treatment plan. It has received considerable attention—and considerable marketing—over the past several years.
TCEC uses topography-guided treatment selectively when a patient’s individual corneal characteristics suggest that it may provide an advantage. However, more customized does not necessarily mean better outcomes for every eye.
Recent well-designed rigorously controlled studies have provided a more nuanced picture than some earlier reports.
A 2026 study using contemporary topography-guided LASIK reported 20/20-or-better uncorrected vision in approximately 87% at six months.⁵
Even more relevant to our approach, a 2025 prospective randomized trial directly compared Wavefront Optimized (WFO) with topography-guided LASIK. WFO numerically led for 20/16-or-better vision (74.6% vs 67%), 20/12.5 vision (29% vs 18%), and refractive accuracy within ±0.50 D (97% vs 91%).⁶
Both technologies can produce excellent outcomes. The important point is that recent randomized studies have not demonstrated a consistent visual-acuity advantage of topography-guided treatment over WFO.⁵,⁶
For the majority of our LASIK patients, that continues to mean precise femtosecond laser flap creation combined with WFO LASIK.
What About Ray-Tracing LASIK?
Ray-tracing LASIK, marketed as WaveLight Plus, is one of the newest approaches to customized LASIK. It combines multiple measurements of the eye to construct an individualized optical model and calculate the ablation.
The concept is interesting, and the early results are promising. In a 2025 well-designed, rigorous randomized study comparing Wavefront Optimized (WFO) with ray-tracing, overall visual acuity outcomes were statistically comparable between the two treatments.⁴
That makes ray-tracing intriguing and relevant—but it remains relatively new compared with the depth and duration of clinical experience accumulated with WFO.
As with topography-guided LASIK, we want longer-term evidence to determine where newer technology provides a meaningful clinical advantage over gold-standard WFO treatment.
Good Technology Starts With Good Patient Selection
Some of the most important advances in LASIK occur before the laser is ever used.
Modern corneal imaging allows us to evaluate corneal shape and thickness in remarkable detail. At TCEC, every LASIK candidate undergoes a comprehensive evaluation of the cornea, prescription, ocular surface, and overall eye health before surgery is recommended.
Good patient selection remains just as important as good laser technology. No single laser platform or treatment algorithm can replace careful evaluation and surgical judgment.
Deciding whether LASIK is appropriate—and which treatment is most appropriate for a particular eye—requires experience you receive from the surgeons at TCEC.
Frequently Asked Questions
How current is TCEC’s LASIK technology?
We utilize customized treatment for both LASIK flap creation and the refractive, vision-correcting ablation.
Wavefront-optimized (WFO) LASIK is a mature, well-established technology and remains our gold-standard benchmark. Published prospective studies consistently demonstrate high visual-acuity outcomes, with approximately 93% to 97% of appropriately selected WFO-treated eyes achieving 20/20 or better.²⁻⁴
We also offer topography-guided technology and use it selectively when we believe it offers an advantage for an individual eye.
Why does TCEC use WFO if newer treatments are available?
Because the results remain excellent with longstanding experience and clinical data to support it.
WFO has repeatedly produced 20/20-or-better vision in well over 90% of appropriately selected eyes, including in contemporary randomized studies.²⁻⁴ Newer “customized” approaches have not consistently demonstrated superior visual-acuity outcomes in randomized clinical trials.⁴⁻⁶
For most LASIK patients, WFO remains our gold-standard benchmark and a highly validated choice.
Is topography-guided LASIK available at TCEC?
We use it selectively when a patient’s corneal anatomy or other characteristics make it advantageous.
Recent randomized studies have not demonstrated a consistent visual-acuity advantage over WFO. One recent rigorous study reported approximately 87% of contemporary topography-guided eyes achieving 20/20 or better, while a separate direct comparison showed WFO numerically outperforming topography-guided treatment on several high-acuity and refractive measures.⁵,⁶
Treatment is selected based on the individual eye—not simply because one technology is newer or marketed as more customized.
What about ray-tracing LASIK?
Early results are promising, and we are following the technology closely. A recent randomized, double-blind fellow-eye study found overall visual acuity after ray-tracing and WFO LASIK to be statistically comparable.⁴
Safety and visual acuity outcomes are the most important things we consider for our LASIK patients, and we will continue to evaluate whether longer-term evidence demonstrates a meaningful advantage for increased utilization at our LASIK facilities.
How do I know if I’m a good candidate for LASIK?
The best way to know is through a comprehensive LASIK evaluation.
Good candidates generally have a stable prescription, healthy corneas, adequate corneal thickness, a healthy ocular surface, and a refractive error within an appropriate treatment range.
At TCEC, the purpose of the consultation is not simply to determine whether we can perform LASIK. It is to determine whether LASIK is the right procedure for your eyes.
How does LASIK compare with other vision correction procedures?
LASIK is one of several modern refractive procedures, along with options such as PRK and SMILE. Each has advantages and limitations depending on the patient’s prescription, corneal anatomy, lifestyle, and other factors.
For an appropriately selected patient, LASIK remains an established and extensively studied refractive procedure.
Will I still need glasses or contacts after LASIK?
The vast majority of patients enjoy complete freedom from glasses and/or contact lenses. LASIK does not stop the eye from aging, and as patients enter into their 40s and 50s, the need for reading glasses is a natural development.
Ready to See Which Technology Fits Your Eyes?
Twin Cities Eye Consultants offers free LASIK consultations across the Twin Cities using advanced diagnostic imaging and our all-laser LASIK platform.
Our philosophy is simple:
The best technology is supported by rigorous studies and long-term data. Surgeons at TCEC emphasize technology with the evidence, precision, and track record to produce the best result for your individual eyes.
Call us at 612-999-2020 or schedule your free LASIK consultation online.
References:
Meide EVH, Ferguson TJ, Berdahl JP, Thompson VM, Terveen DC. Visual acuity and quality of life results in a randomized trial of topography-guided LASIK with GIS software versus wavefront-optimized LASIK. J Refract Surg. 2025;41(7). doi:10.3928/1081597X-20250509-01.
Pietilä J, Huhtala A, Mäkinen P, Uusitalo H. Flap characteristics, predictability, and safety of the Ziemer FEMTO LDV femtosecond laser with the disposable suction ring for LASIK. Eye (Lond). 2014;28(1):66-71. doi:10.1038/eye.2013.244.
Stonecipher KG, Kezirian GM. Wavefront-optimized versus wavefront-guided LASIK for myopic astigmatism with the ALLEGRETTO WAVE: three-month results of a prospective FDA trial. J Refract Surg. 2008;24(4). doi:10.3928/1081597X-20080401-20.
Ziaei M, Mearza AA, Allamby D. Wavefront-optimized laser in situ keratomileusis with the Allegretto Wave Eye-Q excimer laser and the FEMTO LDV Crystal Line femtosecond laser: 6 month visual and refractive results. Cont Lens Anterior Eye. 2015;38(4):245-249. doi:10.1016/j.clae.2015.02.004.
Khoramnia R, Naujokaitis T, Blöck L, et al. Prospective intraindividual comparison of automated customized ray-tracing-guided versus wavefront-optimized LASIK. Ophthalmology. 2025;132(10):1169-1179. doi:10.1016/j.ophtha.2025.05.025.
Dudenhoefer NE, Rodgers SB, Evangelista CB, et al. Comparison of clinical and patient-reported outcomes of contralateral topography-guided vs wavefront-guided LASIK. J Cataract Refract Surg. 2026;52(7):641-649. doi:10.1097/j.jcrs.0000000000001905.
