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Published Online:https://doi.org/10.3928/1081597X-20100212-04Cited by:70

Abstract

Purpose:

To evaluate the monocular and binocular visual outcomes of LASIK with a non-linear aspheric micro-monovision protocol for the correction of myopic astigmatism and presbyopia.

Methods:

A retrospective, noncomparative case series included 310 eyes of 155 consecutive patients with myopic astigmatism and presbyopia who were treated with LASIK-induced micro-monovision. The Carl Zeiss Meditec CRS-Master software and MEL 80 excimer laser were used. The target refraction was plano for distance eyes (dominant eye) and between −0.75 and −2.00 diopters (D) for near eyes. Patients were followed for 1 year. Mean attempted spherical equivalent refraction (SE) correction was −3.59±1.79 D (range: −0.20 to −8.31 D). Mean attempted cylinder correction was 0.84±0.63 D (range: 0 to 2.50 D). Median patient age was 49 years (range: 43 to 63 years). Median follow-up was 12.5 months.

Results:

Outcome measures after all treatments were as follows. Achieved SE correction was within ±0.50 D in 92% and within ±1.00 D in 99% of eyes. Monocular uncorrected distance visual acuity was 20/20 in 99% and 20/32 in 100% of distance eyes. Binocular uncorrected near visual acuity was J2 in 96% and J5 in 100% of patients. Binocular uncorrected visual acuity was 20/20 and J5 in 99% of patients. No eyes lost 2 or more lines of corrected distance visual acuity. There was no change in mesopic contrast sensitivity (CSV-1000) at all spatial frequencies. The average change in refraction between 3 months and 1 year was −0.06±0.31 D.

Conclusions:

This non-linear aspheric myopic micro-monovision protocol was well-tolerated, stable, and effective for treating patients with presbyopia in moderate to high myopic astigmatism.

  • 1.Wright KW, Guemes A, Kapadia MS, Wilson SE. Binocular function and patient satisfaction after monovision induced by myopic photorefractive keratectomy. J Cataract Refract Surg. 1999; 25:177–182.10.1016/S0886-3350(99)80123-0

    Crossref MedlineGoogle Scholar
  • 2.Waring GO. Refractive Keratotomy for Myopia and Astigmatism. St Louis, MO: Mosby; 1991.

    Google Scholar
  • 3.Wyzinski P. Why are refractive surgeons still wearing glasses?Ophthalmic Surg. 1987; 18:349–351.

    LinkGoogle Scholar
  • 4.Goldberg DB. Laser in situ keratomileusis monovision. J Cataract Refract Surg. 2001; 27:1449–1455.10.1016/S0886-3350(01)01001-X

    Crossref MedlineGoogle Scholar
  • 5.Miranda D, Krueger RR. Monovision laser in situ keratomileusis for pre-presbyopic and presbyopic patients. J Refract Surg. 2004; 20:325–328.

    LinkGoogle Scholar
  • 6.Levinger E, Geyer O, Baltinsky Y, Levinger S. Binocular function and patient satisfaction after monovision induced by laser in situ keratomileusis (LASIK) [Hebrew]. Harefuah. 2006; 145:186–190, 246–287.

    MedlineGoogle Scholar
  • 7.Goldberg DB. Comparison of myopes and hyperopes after laser in situ keratomileusis monovision. J Cataract Refract Surg. 2003; 29:1695–1701.10.1016/S0886-3350(03)00462-0

    Crossref MedlineGoogle Scholar
  • 8.Reinstein DZ, Couch DG, Archer TJ. LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80. J Refract Surg. 2009; 25:37–58.

    LinkGoogle Scholar
  • 9.Wachler BS, Krueger RR. Normalized contrast sensitivity values. J Refract Surg. 1998; 14:463–466.

    LinkGoogle Scholar
  • 10.Marcos S, Moreno E, Navarro R. The depth-of-field of the human eye from objective and subjective measurements. Vision Res. 1999; 39:2039–2049.10.1016/S0042-6989(98)00317-4

    Crossref MedlineGoogle Scholar
  • 11.Reinstein DZ, Archer TJ, Couch D, Schroeder E, Wottke M. A new night vision disturbances parameter and contrast sensitivity as indicators of success in wavefront-guided enhancement. J Refract Surg. 2005; 21:S535–S540.

    LinkGoogle Scholar
  • 12.Pande M, Hillman JS. Optical zone centration in keratorefractive surgery. Entrance pupil center, visual axis, coaxially sighted corneal reflex, or geometric corneal center?Ophthalmology. 1993; 100:1230–1237.

    Crossref MedlineGoogle Scholar
  • 13.Reinstein DZ, Archer TJ, Couch D. Accuracy of WASCA aberrometer refraction compared to manifest refraction in myopia. J Refract Surg. 2006; 22:268–274.

    LinkGoogle Scholar
  • 14.Eydelman MB, Drum B, Holladay J, Hilmantel G, Kezirian G, Durrie D, Stulting RD, Sanders D, Wong B. Standardized analyses of correction of astigmatism by laser systems that reshape the cornea. J Refract Surg. 2006; 22:81–95.

    LinkGoogle Scholar
  • 15.Waring GO. Standard graphs for reporting refractive surgery. J Refract Surg. 2000; 16:459–466.

    MedlineGoogle Scholar
  • 16.Reinstein DZ, Waring GO. Graphic reporting of outcomes of refractive surgery. J Refract Surg. 2009; 25:975–978.10.3928/1081597X-20091016-01

    LinkGoogle Scholar
  • 17.Thibos LN, Applegate RA, Schwiegerling JT, Webb R. Standards for reporting the optical aberrations of eyes. J Refract Surg. 2002; 18:S652–S660.

    LinkGoogle Scholar
  • 18.FDA. Checklist of Information Usually Submitted in an Investigational Device Exemptions (IDE) Application for Refractive Surgery Lasers, 1997. Available at: http:/www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm080250.pdf

    Google Scholar
  • 19.Reilly CD, Lee WB, Alvarenga L, Caspar J, Garcia-Ferrer F, Mannis MJ. Surgical monovision and monovision reversal in LASIK. Cornea. 2006; 25:136–138.10.1097/01.ico.0000178722.19317.7b

    Crossref MedlineGoogle Scholar
  • 20.Braun EH, Lee J, Steinert RF. Monovision in LASIK. Ophthalmology. 2008; 115:1196–1202.10.1016/j.ophtha.2007.09.018

    Crossref MedlineGoogle Scholar
  • 21.Adler F. Physiology of the Eye: Clinical Application. 8th ed. St Louis, MO: Mosby; 1987.

    Google Scholar
  • 22.Erickson P. Potential range of clear vision in monovision. J Am Optom Assoc. 1988; 59:203–205.

    MedlineGoogle Scholar
  • 23.Erickson P, McGill EC. Role of visual acuity, stereoacuity, and ocular dominance in monovision patient success. Optom Vis Sci. 1992; 69:761–764.10.1097/00006324-199210000-00003

    Crossref MedlineGoogle Scholar
  • 24.Durrie DS. The effect of different monovision contact lens powers on the visual function of emmetropic presbyopic patients (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2006; 104:366–401.

    MedlineGoogle Scholar
  • 25.Evans BJ. Monovision: a review. Ophthalmic Physiol Opt. 2007; 27:417–439.10.1111/j.1475-1313.2007.00488.x

    Crossref MedlineGoogle Scholar
  • 26.Bennett AG, Rabbetts RB. Clinical Visual Optics. 3rd ed. Burlington, MA: Butterworth-Heinemann Ltd; 1998.

    Google Scholar
  • 27.Duane A. Normal values of the accommodation at all ages. JAMA. 1912; LIX;1010–1013.

    CrossrefGoogle Scholar
  • 28.Heatley CJ, Spalton DJ, Hancox J, Kumar A, Marshall J. Fellow eye comparison between the 1CU accommodative intraocular lens and the Acrysof MA30 monofocal intraocular lens. Am J Ophthalmol. 2005; 140:207–213.10.1016/j.ajo.2005.02.057

    Crossref MedlineGoogle Scholar
  • 29.Hancox J, Spalton D, Heatley C, Jayaram H, Marshall J. Objective measurement of intraocular lens movement and dioptric change with a focus shift accommodating intraocular lens. J Cataract Refract Surg. 2006; 32:1098–1103.10.1016/j.jcrs.2006.01.092

    Crossref MedlineGoogle Scholar
  • 30.Alfonso JF, Fernández-Vega L, Señaris A, Montés-Micó R. Quality of vision with the Acri.Twin asymmetric diffractive bifocal intraocular lens system. J Cataract Refract Surg. 2007; 33:197–202.10.1016/j.jcrs.2006.09.033

    Crossref MedlineGoogle Scholar
  • 31.Chiam PJ, Chan JH, Haider SI, Karia N, Kasaby H, Aggarwal RK. Functional vision with bilateral ReZoom and ReSTOR intraocular lenses 6 months after cataract surgery. J Cataract Refract Surg. 2007; 33:2057–2061.10.1016/j.jcrs.2007.07.029

    Crossref MedlineGoogle Scholar
  • 32.Schmidinger G, Simader C, Dejaco-Ruhswurm I, Skorpik C, Pieh S. Contrast sensitivity function in eyes with diffractive bifocal intraocular lenses. J Cataract Refract Surg. 2005; 31:2076–2083.10.1016/j.jcrs.2005.04.037

    Crossref MedlineGoogle Scholar
  • 33.Kohnen T, Allen D, Boureau C, Dublineau P, Hartmann C, Mehdorn E, Rozot P, Tassinari G. European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. Ophthalmology. 2006; 113:584.e1.10.1016/j.ophtha.2005.11.020

    Crossref MedlineGoogle Scholar
  • 34.Vingolo EM, Grenga P, Iacobelli L, Grenga R. Visual acuity and contrast sensitivity: AcrySof ReSTOR apodized diffractive versus AcrySof SA60AT monofocal intraocular lenses. J Cataract Refract Surg. 2007; 33:1244–1247.10.1016/j.jcrs.2007.03.052

    Crossref MedlineGoogle Scholar
  • 35.Schor C, Erickson P. Patterns of binocular suppression and accommodation in monovision. Am J Optom Physiol Opt. 1988; 65:853–861.

    Crossref MedlineGoogle Scholar
  • 36.Artola A, Patel S, Schimchak P, Ayala MJ, Ruiz-Moreno JM, Alió JL. Evidence for delayed presbyopia after photorefractive keratectomy for myopia. Ophthalmology. 2006; 113:735–741.e1.10.1016/j.ophtha.2006.01.054

    Crossref MedlineGoogle Scholar
  • 37.Marcos S, Barbero S, Jimenez-Alfaro I. Optical quality and depth-of-field of eyes implanted with spherical and aspheric intraocular lenses. J Refract Surg. 2005; 21:223–235.

    LinkGoogle Scholar
  • 38.Eser I, Durrie DS, Schwendeman F, Stahl JE. Association between ocular dominance and refraction. J Refract Surg. 2008; 24:685–689.

    LinkGoogle Scholar
  • 39.Yang Z, Lan W, Liu W, Chen X, Nie H, Yu M, Ge J. Association of ocular dominance and myopia development: a 2-year longitudinal study. Invest Ophthalmol Vis Sci. 2008; 49:4779–4783.10.1167/iovs.07-1616

    Crossref MedlineGoogle Scholar

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