Changes to corneal aberrations and vision after Presbylasik refractive surgery using the MEL 80 platform

Clinical outcomes of presbyopia correction with the latest techniques of presbyLASIK: a systematic review

The aim of this study was to collect the scientific literature on the correction of presbyopia with laser in situ keratomileusis (presbyLASIK) in last years and to analyse the quality of such scientific evidence using a validated methodology for conducting a systematic review. A total of 42 articles were initially identified, but after applying the selection criteria and an additional manual search a total of 23 articles were finally included: 2 non-randomized controlled clinical trials (NRCT) and 21 case series. Quality assessment of NRCTs and case series was performed with the ROBINS-I and the 20-criterion quality appraisal checklist defined by Moga et al. (IHE Publ 2012), respectively. For NRCT, the risk of bias was moderate in one study and serious in the other NRCT, being the main sources of risk, the domains related to confounding, selection of participants and measurement of outcomes. For case series studies, the main source of risk of bias was subjects not entering the study at the same point of the conditions (different levels of presbyopia). Likewise, a significant level of uncertainty was detected for the following items: consecutive recruitment of patients, blinding of outcome assessors to the intervention that the patient received, and conclusions of the study not supported by the results. Research on presbyLASIK to this date is mainly focused on case series generating a limited level of scientific evidence. The two NRCTs identified only demonstrated the potential benefit of combining the multiaspheric profile with some level of monovision in the non-dominant eye.

PRESBYOND Laser Blended Vision LASIK in Commercial and Military Pilots Requiring Class 1 Medical Certification

PURPOSE

To report the outcomes of PRESBYOND Laser Blended Vision LASIK (Carl Zeiss Meditec AG) in presbyopic commercial and military pilots requiring Class 1 aeromedical certification.

METHODS

This was a retrospective study of 23 consecutive pilots who underwent PRESBYOND Laser Blended Vision LASIK. Postoperative visits were conducted at 1 day and 1, 3, and 12 months. Standard outcomes analysis was performed using the data at 12 months. Objective quality of vision measures including mesopic contrast sensitivity (CSV-1000; VectorVision), Ocular Scatter Index (HD Analyzer; Keeler), and straylight (C-Quant; Oculus Optikgeräte GmbH) were determined before and 3 months after surgery. A questionnaire to assess the functional vision of pilots before and after surgery was derived to record subjective outcomes.

RESULTS

Of the 23 pilots treated, data were available at 12 months for 22 pilots (95.7%) and at 3 months for 1 pilot (4.3%). Median age was 55 years (range: 42 to 65 years). At 12 months, binocular uncorrected distance visual acuity was 20/20 or better in 100% and 20/16 or better in 52% of pilots. Binocular uncorrected intermediate visual acuity was J3 in 73%, J5 in 95%, and J10 in 100% of pilots. Binocular uncorrected near visual acuity was J1 or better in 78% and J2 or better in 100% of pilots. Mean postoperative spherical equivalent refraction relative to the target was -0.04 ± 0.34 diopters (D) (range: -0.63 to +0.63 D), with 93% within ±0.50 D. There was a statistically significant increase in contrast sensitivity at 3, 6, 12, and 18 cpd. C-Quant straylight was 1.07 ± 0.16 before surgery and 1.06 ± 0.16 at 1 to 3 months after surgery (P = .705). All pilots achieved Class 1 medical certification from the United Kingdom Civil Aviation Authority and resumed flying. All pilots reported improved functionality compared to the previous vision correction method.

CONCLUSIONS

PRESBYOND Laser Blended Vision LASIK enabled presbyopic commercial pilots to continue to fly without the need for glasses. With consideration of the visually challenging cockpit environment, PRESBYOND Laser Blended Vision LASIK provides clear continuous vision for tasks at near, intermediate, and far distance. Class 1 pilots reported a subjective improvement in visual tasks and comfort following surgery. [J Refract Surg. 2023;39(1):6-14.].

Functional Outcomes and Reading Speeds following PRESBYOND LBV Using Nonlinear Aspheric Ablation Profiles Combined with Micro-Monovision

Purpose

To report the functional outcomes and reading speeds following PRESBYOND laser blended vision (LBV) using nonlinear aspheric ablation profiles with micro-monovision with the Carl Zeiss Meditec MEL 90 platform.

Methods

Data have been collected retrospectively for all patients who underwent PRESBYOND LBV using the MEL 90 excimer laser. Postoperative binocular uncorrected distance and near visual acuity, stereo-acuity, contrast sensitivity, and reading performance were compared with pre-op values measured with patient's progressive glasses. Mean follow-up was 6 ± 1.2 months.

Results

Sixty eyes of 30 patients (mean age 50.47 ± 6.43 years) were included. Of these, 18 patients were hyperopic and 12 patients were myopic with mean SE of 1.28 ± 1.38 D and −2.84 ± 1.86 D, respectively. At 6 months, the mean binocular UDVA was ≥−0.03 ± 0.06 log MAR and the mean binocular UNVA was ≥0.22 ± 0.04 log MAR. The uncorrected reading speeds (words per minute) at the preferred reading distance of 46.17 cm, 60 cm, and 80 cm were significantly better (p value <0.01), whereas the smallest letter size and reading acuities were comparable to the preoperative values (p > 0.05 for all distances). Uncorrected contrast sensitivity log values showed mild reduction; however, this was not statistically significant for any spatial frequency. There was a significant reduction in post uncorrected stereopsis to 89.67 arc sec, compared with pre-op corrected stereopsis (50.67 arc sec); however, it recovered fully with near correction (53.33 arc sec, p > 0.05 compared with pre).

Conclusion

PRESBYOND LBV resulted in significantly better reading speeds and satisfactory functional visual outcomes, without a permanent change in stereo-acuity and contrast sensitivity 6 months postoperatively.

PresbyLASIK: A review of PresbyMAX, Supracor, and laser blended vision: Principles, planning, and outcomes

PresbyLASIK is one of the most commonly used modalities of surgical correction in presbyopes with no cataract. Unlike monovision procedures, both the eyes are adjusted for near and distance, providing a good stereopsis. This works by creating a corneal multifocality and increasing the depth of focus. Most techniques of presbyLASIK currently employ hybrid methods, i.e., a component of monovision added on to a multifocal corneal ablation. Choosing an appropriate proportion of these two components according to the patients' requirements and meticulous patient selection are key to obtaining desirable outcomes. Being corneal-based procedures, presbyLASIK has shown to be reversible. Thorough updated knowledge of the different presbyLASIK procedures, their principles and outcomes based on previous studies is required before a refractive surgeon plans to start providing presbyLASIK services. We performed a comprehensive search on PubMed with the keywords "Presbyopia surgery," "PresbyLASIK" "PresbyMAX," "Supracor," and "Custom-Q." In this review article, we have explained the principles of the various presbyLASIK procedures, appropriate patient selection and planning on the devices with examples, and summarized the previously published outcomes of these techniques.

Visual and Refractive Outcomes Following Laser Blended Vision Using Non-linear Aspheric Micro-monovision

PURPOSE

To report 1-year visual and refractive outcomes following PRESBYOND Laser Blended Vision using non-linear aspheric micro-monovision with the MEL 90 platform (Carl Zeiss Meditec GmbH).

METHODS

Data were collected retrospectively for all patients who underwent treatment for simultaneous correction of refractive error and presbyopia from June 2015 to June 2018. Only those patients who completed at least 6 months of follow-up were included in the study.

RESULTS

A total of 101 patients with a mean age of 51.05 ± 5.15 years (range: 40 to 65 years), of whom 38 patients had myopic and 63 patients had hyperopic refractive error with or without astigmatism, were included in the study. Mean preoperative spherical equivalent was -3.36 ± 1.86 diopters (D) in the myopia group and +1.75 ± 0.99 D in the hyperopia group. At 1 year, the mean spherical equivalent refraction was +0.13 ± 0.32 D in the distance eye and -1.42 ± 0.33 D (range: -0.88 to -2.50 D) in the near eye in the myopia group and -0.13 ± 0.24 D in the distance eye and -1.28 ± 0.31 D (range: -0.63 to -2.00 D) in the near eye in the hyperopia group. Two eyes in the hyperopia group underwent early enhancement for the near eye at 3 months. Ninety-seven percent of the patients in the myopia group and 96% in the hyperopia group were satisfied with their distance vision. Near vision satisfaction score was 95% for the myopia group and 89% for the hyperopia group.

CONCLUSIONS

At 1 year, the aspheric micro-monovision protocol resulted in satisfactory and fairly stable visual outcomes in both myopic and hyperopic individuals. [J Refract Surg. 2020;36(5):300-307.].

Visual quality assessment after presbyopic laser in-situ keratomileusis

AIM

To assess visual quality after presbyopia correction using an aspheric ablation profile and a micro-monovision protocol.

METHODS

This is a retrospective interventional study. Fifty-four eyes of 27 patients (mean age, 50.2±7.5y) who underwent presbyopia correction with an aspheric micro-monovision protocol were enrolled. The values of modulation transfer function (MTF) cutoff frequency, Strehl ratio, objective scattering index (OSI) and accommodation range were quantitatively assessed using the HD analyzer. Preoperative and postoperative contrast sensitivity (CS) at far (2.5 m) and near (40 cm) distance and higher-order aberrations (HOAs) were analyzed. Subjective visual satisfaction was evaluated by self-reported questionnaire regarding optical visual symptoms.

RESULTS

One year after presbyopia correction, no significant differences were found in the MTF cutoff frequency, Strehl ratio and OSI, however, the HD analyzer accommodation range significantly differed postoperatively (P=0.004). Postoperative CS at 12 and 18 cpd at near showed statistically significant improvement (P=0.020 and 0.008, respectively). Visual performance by self-reported questionnaire revealed satisfactory results in terms of subjective visual quality improvement.

CONCLUSION

Objective optical quality parameters show good visual outcomes. Subjective visual quality assessed by self-reported questionnaire in the presbyopia correction group show satisfactory results.

Aspheric Micro-monovision LASIK in Correction of Presbyopia and Myopic Astigmatism: Early Clinical Outcomes in a Chinese Population

PURPOSE

To analyze early clinical outcomes of aspheric micro-monovision LASIK for correction of presbyopia and myopia with or without astigmatism.

METHODS

Prospective, non-comparative case series of 80 eyes of 40 patients with a mean age of 43.4 ± 4.9 years (range: 38 to 63 years) treated bilaterally using an aspheric micro-monovision protocol. The target refraction was plano for the distance eye and between -0.75 and -2.25 diopters (D) for the near eye. Visual acuity, ocular aberrations, contrast sensitivity, corneal topography, amplitude of accommodation, binocular sensorial function, and satisfaction score questionnaires were evaluated at 3 months after surgery.

RESULTS

Three months after surgery, the mean spherical equivalent (SE) refraction in the distance eye was -0.08 ± 0.27 D, whereas the attempted and achieved SE in the near eye were -1.41 ± 0.28 and -1.32 ± 0.35 D, respectively. Ninety-three percent of eyes were within ±0.50 D of target correction of SE. The uncorrected distance visual acuity (UDVA) after surgery was -0.10 ± 0.06 logMAR (20/15.5), 0.22 ± 0.12 logMAR (20/34), and -0.11 ± 0.06 logMAR (20/15), for distance eyes, near eyes, and binocularly, respectively. Ninety-five percent of patients achieved simultaneously uncorrected distance visual acuity 0.0 logMAR (20/20) or better and uncorrected near visual acuity J2 (20/25) or better. Stability was achieved from 1 week of follow-up. The overall satisfaction score for surgery was 92 ± 6.

CONCLUSIONS

The aspheric micro-monovision protocol provided a well-tolerated and effective means for treating myopic astigmatism and alleviating presbyopic symptoms simultaneously. [J Refract Surg. 2016;32(10):680-685.].

Corneal compensation of presbyopia: PresbyLASIK: an updated review

Abstract

The main purpose of this review is to compare and analyze the results of the main PresbyLASIK approaches; central and peripheral.

Summary

A comprehensive research was conducted in PUBMED using keywords like “presbyopia correction”, “PresbyLASIK”, “Corneal multifocality”, “Laser blended vision”. We reviewed the PresbyLASIK technique, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), and corrected near visual acuity (CNVA), and compared the differences between the techniques.

Hydrogel Inlay for Presbyopia: Objective and Subjective Visual Outcomes

PURPOSE

To evaluate changes in visual performance and ocular optical quality after implantation of a corneal hydrogel inlay as a treatment for presbyopia.

METHODS

A Raindrop Near Vision Inlay (ReVision Optics, Lake Forest, CA) was implanted monocularly on the stromal bed of a femtosecond laser-assisted generated corneal flap of non-dominant eyes of 22 patients with emmetropic presbyopia (preoperative spherical equivalent range: -0.50 to 1.00 diopters). Efficacy was determined by measuring near and distance visual acuities and ocular aberrations, and satisfaction was assessed by a patient questionnaire.

RESULTS

The preoperative monocular uncorrected near visual acuity of the inlay inserted eye was 20/129 ± 1 Snellen (range: 20/135 to 20/61 Snellen) and improved to 20/35 ± 2 Snellen (range: 20/61 to 20/20 Snellen) (P < .01) at 6 months postoperatively. The monocular uncorrected distance visual acuity of the eye receiving the inlay was 20/25 ± 2 Snellen (range: 20/50 to 20/20 Snellen) preoperatively and 20/25 ± 1 Snellen (range: 20/50 to 20/20 Snellen) at 6 months postoperatively (P =.257). According to the questionnaire responses, 82% of patients were satisfied. This was despite near glasses needs remaining in 13.6% of the cohort and the presence of glare and a decrease in night vision in approximately 40% of patients. The primary spherical aberration coefficient Z4(0) changed from positive to negative values in all patients (P < .01). However, the point spread function showed no significant change.

CONCLUSIONS

Hydrogel corneal inlays improve uncorrected near visual acuity in patients with presbyopia with only moderate effect on visual quality. However, the satisfaction with this therapy was relatively lower in these Korean patients than that reported previously in Western patients.