Micro-Monovision

PURPOSE

To report the visual, refractive and subjective outcomes of presbyLASIK for the correction of presbyopia.

METHODS

Monocular (20 eyes) or micro-monovision (12 eyes) presbyLASIK was performed on a total of 32 eyes in 16 patients (50% female, average age 55±4.6 years) using the Zeiss VisuMax 400Hz femtosecond and Schwind Amaris 1050RS excimer laser platform. Predictability, safety and efficacy were assessed and compared at 4-6 weeks, 3 months and 6 months. Results were considered significant if P < 0.05.

RESULTS

For monocular treatments, average postoperative spherical equivalent (SE) was 0.1±0.1 D and -0.86±0.5 D at 4-6 weeks postoperatively for distance and near eyes respectively; 90% eyes achieved SE ±1.0 D of the target. Postoperative binocular uncorrected distance (UDVA), intermediate (UIVA) and near visual acuity (UNVA) were -0.03±0.1 LogMAR (20/20), 0.09±0.26 LogMAR (N4) and 0.29±0.11 LogMAR (N6) respectively with 90% patients achieving binocular UDVA of 20/20 or better. For micro-monovision treatments, average postoperative SE was -0.33±0.51 D and -1.60±0.78 D at 4-6 weeks postoperatively for distance and near eyes respectively; 100% eyes achieved SE ±1.0 D of the target. Postoperative binocular UDVA, UIVA and UNVA were 0.05±0.16 LogMAR (20/20), -0.02±0.10 LogMAR (N3) and 0.23±0.08 LogMAR (N5) respectively with 67% patients achieving binocular UDVA of 20/20 or better.

CONCLUSION

Monocular and micro-monovision presbyLASIK are both effective options for the treatment of presbyopia. Monocular treatments are more likely to be well tolerated by patients who prefer to preserve exceptional distance vision, while micro-monovision treatments may be better suited to patients who can tolerate compromises in distance vision in order to attain greater intermediate vision function.

Multifocal Femto-PresbyLASIK in Pseudophakic Eyes

BACKGROUND

Presbyopia treatment in pseudophakic patients with a monofocal IOL is challenging. This study investigates the refractive results of femto-PresbyLASIK and analyzes presbyopia treatment in pseudophakic eyes.

METHODS

14 patients with 28 pseudophakic eyes were treated with femto-PresbyLASIK. The dominant eye was targeted at a distance and the non-dominant eye at -0.5 D. The presbyopic algorithm creates a steepness in the cornea center by using an excimer laser that leads to corneal multifocality.

RESULTS

6 months after surgery a refraction of -0.11 ± 0.13 D (p = 0.001), an uncorrected distance visual acuity of 0.05 ± 1.0 logMAR (p < 0.001) and an uncorrected near visual acuity of 0.15 ± 0.89 logMAR (p = 0.001) were achieved in the dominant eye. For the non-dominant eye, the refraction was -0.28 ± 0.22 D (p = 0.002), the uncorrected distance of visual acuity was 0.1 ± 1.49 logMAR, and the uncorrected near visual acuity was 0.11 ± 0.80 logMAR (p < 0.001). Spherical aberrations (Z400) were reduced by 0.21-0.3 µm in 32% of eyes, and by 0.31-0.4 µm in 26% of eyes.

CONCLUSION

By steepening the central cornea while maintaining spherical aberrations within acceptable limits, PresbyLASIK created a corneal multifocality that safely improved near vision in both eyes. Thus, femto-PresbyLASIK can be used to treat presbyopia in pseudophakic eyes without performing intraocular surgery.

One year results of presbyLASIK using hybrid bi-aspheric micro-monovision ablation profile in correction of presbyopia and myopic astigmatism

AIM

To analyze one year clinical outcomes and subjective rating of hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision for correction of presbyopia and myopic astigmatism.

METHODS

Seventy-four eyes of 37 patients consecutively treated with presbyLASIK were assessed. The mean age of the patients was 43.8±3.0y with a mean spherical equivalent refraction of -5.21±1.87 diopters (D) and mean astigmatism of -0.82±0.64 D. Visual acuity, manifest refraction, contrast sensitivity, aberrometry and patients' subjective rating were evaluated pre- and postoperatively.

RESULTS

At 1y postoperatively (68 eyes of 34 patients), the mean spherical equivalent (SE) refraction in distance eyes was 0.06±0.05 D, whereas the achieved SE in near eyes was -0.83±0.05 D. Ninety-nine percent of eyes were within ±0.50 D of target correction of SE. The binocular mean uncorrected distance visual acuity (UDVA) was 0.00±0.18 logMAR (20/20). Sixty-four percent of patients achieved 0.0 logMAR (20/20) or better of UDVA and 0.1 logRAD or better of UNVA as well. There was a binocularly loss of one line CDVA after surgery for only one patient (3%, 1/34) and no patient lost 2 lines. The changes in binocular contrast sensitivity (CS) in all test conditions were not significant at any frequency after surgery. The changes of entire eye total higher order aberrations (tHOA) and spherical aberrations (SA) significantly higher in near eyes than in distance eyes. The overall satisfaction score for surgery was 93±8.

CONCLUSION

The hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision appears to be an efficacious option for myopic presbyopes. One year postoperative outcomes in a relatively young presbyopia population indicate improvements in both far and near vision with high satisfaction.

A Novel Laser Refractive Surgical Treatment for Presbyopia: Optics-Based Customization for Improved Clinical Outcome

Laser Assisted in Situ Keratomileusis (LASIK) is a proven treatment method for corneal refractive surgery. Surgically induced higher order optical aberrations were a major reason why the method was only rarely used to treat presbyopia, an age-related near-vision loss. In this study, a novel customization algorithm for designing multifocal ablation patterns, thereby minimizing induced optical aberrations, was used to treat 36 presbyopic subjects. Results showed that most candidates went from poor visual acuity to uncorrected 20/20 vision or better for near (78%), intermediate (92%), and for distance (86%) vision, six months after surgery. All subjects were at 20/25 or better for distance and intermediate vision, and a majority (94%) were also better for near vision. Even though further studies are necessary, our results suggest that the employed methodology is a safe, reliable, and predictable refractive surgical treatment for presbyopia.