Hyperopia shows the strongest association with LASIK retreatment Andreas Frings, 1 Elisa Intert, 2 Johannes Steinberg, 2,3,4 Vasyl Druchkiv, 2,3 Stephan J. Linke 2,3,4 and Toam Katz 2,3 1 Department of Ophthalmology, Heinrich- Heine-University D€ usseldorf, D€ usseldorf, Germany; 2 Department of Ophthalmology, University Medical Centre Hamburg- Eppendorf (UKE), Hamburg, Germany; 3 Care Vision GmbH, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany; 4 Zentrumsehst€ arke, Hamburg, Germany doi: 10.1111/aos.13486 Editor, A recently published large-scale study (Mimouni et al. 2016) identified hyperopia as the parameter that demonstrated the strongest asso- ciation with retreatment after excimer laser refractive surgery. We do share this observation as we also note less accurate refractive pre- dictability and, most frequently, final undercorrection after hyperopic cor- neal refractive surgery. To improve refractive predictability, preceding studies (Zaldivar et al. 2005; Spadea et al. 2006) suggested that preoperative cycloplegic or manifest refraction, or a combination of both (Zadok et al. 2003), could be used in the laser nomogram. Previously, we reported that a manifest-cycloplegic difference (MCD) in spherical equivalent (SE) of 1.00 dioptre (D) or more occurs in about 13% of hyperopic eyes. In these cases, a correction of the manifest SE only did not appear to be adequate (Frings et al. 2016a). In a recent multicentre study, we thus evaluated the efficacy, predictabil- ity and safety of LASIK retreatment based on manifest refraction in hyper- opic patients with a preoperative dif- ference between cycloplegic and manifest refraction of 1.00 D or less who had LASIK retreatment based on manifest refraction. We analysed the refractive outcome of 113 hyperopic eyes according to standard graphs for reporting the efficacy, predictability and safety of refractive surgery. We found that efficacy (p < 0.001) and safety (p = 0.004) were statistically sig- nificant improved by the retreatment without being negatively influenced by preoperative manifest SE, manifest cylinder or keratometry, which we analysed. Still showing a trend towards undercorrection, retreatment resulted in 88 eyes (78.0%) that reached Æ0.50 D of the attempted correction. The optical zone diameter of the retreatment did not correlate with effi- cacy, predictability or safety. Treat- ment predictability, however, was statistically significant worse in eyes with a preoperative SE of more than 2.50 D (p = 0.005, tested with chi- square test). In our opinion, the main objective criterion for a retreatment is a differ- ence between targeted and achieved manifest SE of 0.50 D or more after at least 6 months. We do not retreat eyes earlier after LASIK as keratometric and refractive changes are likely to occur up to 6 months (Frings et al. 2016b). The results of our study indicate that in hyperopic eyes with a preoperative difference between cycloplegic and manifest refraction of 1.00 D or less a LASIK retreatment is efficient, pre- dictable and safe and therefore, finally meets preoperative patients’ expecta- tions. To summarize, the improvement of hyperopic LASIK still is a matter of discussion, hyperopes should not be treated earlier than 6 months and the difference between cycloplegic and manifest refraction should be taken into account during treatment plan- ning. Many hyperopic cases will likely need a retreatment, most of which result in high efficacy, predictability and safety after all. We would highly recommend clarifying this fact to hyperopic LASIK candidates before the treatment. References Frings A, Richard G, Steinberg J, Druchkiv V, Linke SJ & Katz T (2016a): LASIK and PRK in hyperopic astigmatic eyes: is early retreatment advisable? Clin Ophthalmol 10: 565–570. Frings A, Steinberg J, Druchkiv V, Linke SJ & Katz T (2016b): Role of preoperative cyclo- plegic refraction in LASIK treatment of hyperopia. Graefes Arch Clin Exp Ophthal- mol 254: 1399–1404. Mimouni M, Vainer I, Shapira Y, Levartovsky S, Sela T, Munzer G & Kaiserman I (2016): Factors Predicting the Need for Retreatment After Laser Refractive Surgery. Cornea 35: 607–612. Spadea L, Sabetti L, D’Alessandri L & Balestrazzi E (2006): Photorefractive kera- tectomy and LASIK for the correction of hyperopia: 2-year follow-up. J Refract Surg 22: 131–136. Zadok D, Raifkup F, Landau D & Frucht- Pery J (2003): Long-term evaluation of hyperopic laser in situ keratomileusis. J Cataract Refract Surg 29: 2181–2188. Zaldivar R, Oscherow S & Bains HS (2005): Five techniques for improving outcomes of hyperopic LASIK. J Refract Surg 21: 628– 632. Correspondence: Andreas Frings, MD Department of Ophthalmology Heinrich-Heine-University D€ usseldorf Moorenstraße 5 40225 D€ usseldorf Germany Tel: +49 211 81 173 33 Fax: +49 211 81 173 40 Email: andi.frings@gmail.com Validation of the CHOP model for detecting severe retinopathy of prematurity in a cohort of Colorado infants Emily A McCourt, Brandie Wagner, Jennifer Jung, Erica Wymore, Jasleen Singh, Robert Enzenauer, Rebecca Braverman and Anne Lynch University of Colorado Denver School of Medicine, Aurora, CO, USA doi: 10.1111/aos.13506 Editor, W e read with great interest ‘Pre- dictive algorithms for early detection of retinopathy of prematu- rity’ (ROP) by Piermarocchi et al. (2016). The authors evaluated the sen- sitivity and specificity of three predic- tive ROP algorithms (WINROP, ROP Score and CHOP-ROP) in a cohort of 445 preterm infants. Current 2013 ROP screening guide- lines are extremely sensitive and detect virtually all cases of ROP in the USA. Acta Ophthalmologica 2018 e404