LASIK for Hyperopic Astigmatism and Presbyopia Using Micro-monovision With the Carl Zeiss Meditec MEL80 Platform

Abstract

Purpose: To evaluate the monocular and binocular outcomes of LASIK for a micro-monovision protocol for the correction of hyperopic astigmatism and presbyopia. Methods: A prospective non-comparative case series included 258 eyes of 129 consecutive patients with hyperopic astigmatism and presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the Carl Zeiss Meditec MEL80 excimer laser. The target refraction was plano for distance eyes (dominant eye) and between −1.00 and −1.50 diopters (D) for near eyes. Patients were followed for 1 year. Results: Mean attempted spherical equivalent refraction (SE) correction was +2.54±1.16 D (range: +0.25 to +5.75 D). Mean attempted cylinder was −0.52±0.49 D (range: −0.00 to −3.25 D). Median age was 56 years (range: 44 to 66 years). Median follow-up was 12.5 months (range: 3.3 months [early retreatment] to 18.2 months). The retreatment rate was 22%. Outcome measures after all treatments were as follows. Mean deviation from the intended SE correction was +0.09±0.48 D, with 79% of eyes within ±0.50 D and 95% within ±1.00 D. The cylinder correction ratio was 1.23±0.63 and the error ratio was 0.67±0.65. Of the distance eyes, 86% achieved uncorrected visual acuity of 20/20 and 100% achieved 20/40. Binocularly, 95% of patients achieved 20/20 and 100% achieved 20/40. Eighty-one percent of patients could read J2 and 100% could read J5. Binocularly, 95% of patients achieved 20/20 and could read J5. No eyes lost 2 or more lines of best spectacle-corrected visual acuity. A statistically significant increase was noted in contrast sensitivity at 3 and 6 cycles per degree (cpd), with no reduction at 12 and 18 cpd. The average change in refraction between 3 months and 1 year was +0.11±0.36 D with a change of >1.00 D in 2.6% of eyes. Conclusions: This hyperopic micro-monovision protocol was a well-tolerated and effective procedure for treating patients with presbyopia in moderate to high hyperopia with corrections ranging up to +5.75 D. Contrast sensitivity was improved and the distance vision of near eyes was found to contribute positively to binocular distance vision compared to distance eyes monocularly. [ J Refract Surg . 2009;25:37–58.]

Changes to Corneal Aberrations and Vision After Monovision in Patients With Hyperopia After Using a Customized Aspheric Ablation Profile to Increase Corneal Asphericity (Q-factor)

“…Our outcomes for UDVA, UNVA, and CDVA loss of two or more lines and re-treatment percentage were similar to recent published studies using presbyopic LASIK with central multifocal ablation profiles in hyperopic patients. 2,4,5,[23][24][25][26][27][28] The proportion of patients achieving 20/20 or better binocular UDVA varied from 36.6% to 93% in the study from Reinstein et al 4 (vs 91% in our study). The proportion of patients achieving Jaeger 3 (Parinaud 4) or better binocular UNVA varied from 60% to 100% in the study by Jackson et al 2 (vs 93% in our study).…”

“…The proportion of patients achieving Jaeger 3 (Parinaud 4) or better binocular UNVA varied from 60% to 100% in the study by Jackson et al 2 (vs 93% in our study). The proportion of patients with a loss of two or more lines of CDVA varied from 25% to 0.5% for Reinstein et al 4 (vs 0% in our study) and the re-treatment rate varied from 21.7% to 0% for Luger et al 24 (vs 10.8% in our study). Clinical outcomes using different techniques of presbyopic LASIK were reported and summarized in several recent studies.…”

Developments in the correction of presbyopia II: surgical approaches

“…As in the case of contact lens correction, corneal refractive surgery can be used to give monovision or modified monovision, in which one or both eyes are made multifocal. In laser blended vision, the DOF of both individual eyes is widened through the use of an aspheric ablation profile to produce increased, but still moderate, levels of spherical aberration. This avoids the marked monocular image degradation associated with attempts to produce greatly enhanced DOF through high levels of spherical aberration.…”

“…This avoids the marked monocular image degradation associated with attempts to produce greatly enhanced DOF through high levels of spherical aberration. The dominant eye is corrected to emmetropia and the non‐dominant eye to −1.50 D. It is claimed that not only is acuity good at distance, intermediate and near but also that there is very little loss in stereoacuity …”

Intrastromal femtosecond laser surgical compensation of presbyopia with six intrastromal ring cuts: 3-year results

“…Globally, functional presbyopia affected an estimated 1.04 billion people in 2005 1. Various surgical treatment options are available, for example, refractive lens exchange with implantation of multifocal2–5 or accommodating intraocular lenses (IOL),6 monovision procedures,7 8 intracorneal inlays9–12 or multifocal ablation of the cornea 13–15. However, some patients hesitate to have such invasive procedures.…”