Abstract
PURPOSE:
To evaluate the monocular and binocular visual outcomes of LASIK with an aspheric micro-mono-vision protocol in emmetropic patients with presbyopia.
METHODS:
A retrospective, noncomparative case series included 296 eyes from 148 consecutive emmetropic patients with presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the MEL 80 excimer laser (Carl Zeiss Meditec) and flaps were created using the VisuMax femtosecond laser (Carl Zeiss Meditec). The target refraction was plano for distance eyes (dominant eye) and between −1.00 and −1.88 diopters (D) for near eyes. Patients were followed for 1 year. Emmetropia was defined for inclusion as spherical equivalent refraction ⩾− 0.88 D, sphere ⩽+1.00 D, and cylinder ⩽1.25 D. Median patient age was 55 years (range: 44 to 65 years). Median follow-up was 12.9 months.
RESULTS:
Mean deviation from intended correction was +0.02±0.35 D, with 91% within ±0.50 D and 100% within ±1.00 D. Of distance eyes, 95% achieved uncorrected distance visual acuity (UDVA) of 20/20 or better and 100% achieved 20/32 or better. Binocularly, 98% of patients achieved UDVA of 20/20 or better and 100% achieved 20/32 or better; 96% achieved uncorrected near visual acuity of J2 and 99% could read J3 or better. No eyes lost 2 or more lines of corrected distance visual acuity. An average increase of 0.05 logMAR was noted in distance-corrected near visual acuity. A small increase occurred in mesopic contrast sensitivity (CSV-1000, VectorVision Inc) at 3 cycles per degree (cpd) (P=.016) and no change at 6, 12, or 18 cpd.
CONCLUSIONS:
This aspheric micro-monovision protocol was a well-tolerated and effective procedure for treating emmetropic patients with presbyopia.
- 1.Ayoubi MG, Leccisotti A, Goodall EA, McGilligan VE, Moore TC. Femtosecond laser in situ keratomileusis versus conductive keratoplasty to obtain monovision in patients with emmetropic presbyopia. J Cataract Refract Surg. 2010; 36(6):997–1002.
10.1016/j.jcrs.2009.12.035 Crossref Medline, Google Scholar - 2.Alió JL, Amparo F, Ortiz D, Moreno L. Corneal multifocality with excimer laser for presbyopia correction. Curr Opin Ophthalmol. 2009; 20(4):264–271.
10.1097/ICU.0b013e32832a7ded Crossref Medline, Google Scholar - 3.Seyeddain O, Riha W, Hohensinn M, Nix G, Dexl AK, Grabner G. Refractive surgical correction of presbyopia with the AcuFocus small aperture corneal inlay: two-year follow-up. J Refract Surg. 2010; 26(10):707–715.
10.3928/1081597X-20100408-01 Link, Google Scholar - 4.Yilmaz OF, Alagoz N, Pekel G, Intracorneal inlay to correct presbyopia: long-term results. J Cataract Refract Surg. 2011; 37(7):1275–1281.
10.1016/j.jcrs.2011.01.027 Crossref Medline, Google Scholar - 5.Dexl AK, Seyeddain O, Riha W, One-year visual outcomes and patient satisfaction after surgical correction of presbyopia with an intracorneal inlay of a new design. J Cataract Refract Surg. 2011; 38(2):262–269.
10.1016/j.jcrs.2011.08.031 Crossref Medline, Google Scholar - 6.Waring GO. Correction of presbyopia with a small aperture corneal inlay. J Refract Surg. 2011; 27(11):842–845.
10.3928/1081597X-20111005-04 Link, Google Scholar - 7.Ruiz LA, Cepeda LM, Fuentes VC. Intrastromal correction of presbyopia using a femtosecond laser system. J Refract Surg. 2009; 25(10):847–854.
10.3928/1081597X-20090917-05 Link, Google Scholar - 8.Holzer MP, Mannsfeld A, Ehmer A, Auffarth GU. Early outcomes of INTRACOR femtosecond laser treatment for presbyopia. J Refract Surg. 2009; 25(10):855–861.
10.3928/1081597X-20090917-06 Link, Google Scholar - 9.Alfonso JF, Fernandez-Vega L, Valcarcel B, Ferrer-Blasco T, Montes-Mico R. Outcomes and patient satisfaction after presbyopic bilateral lens exchange with the ReSTOR IOL in emmetropic patients. J Refract Surg. 2010; 26(12):927–933.
10.3928/1081597X-20100114-01 Link, Google Scholar - 10.Reinstein DZ, Archer TJ, Gobbe M. LASIK for myopic astigmatism and presbyopia using non-linear aspheric micro-monovision with the Carl Zeiss Meditec MEL 80 platform. J Refract Surg. 2011; 27(1):23–37.
10.3928/1081597X-20100212-04 Link, Google Scholar - 11.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(1):37–58. Link, Google Scholar
- 12.Pinelli R, Ortiz D, Simonetto A, Bacchi C, Sala E, Alio JL. Correction of presbyopia in hyperopia with a center-distance, paracentral-near technique using the Technolas 217z platform. J Refract Surg. 2008; 24(5):494–500. Link, Google Scholar
- 13.Epstein RL, Gurgos MA. Presbyopia treatment by monocular peripheral presbyLASIK. J Refract Surg. 2009; 25(6):516–523. Link, Google Scholar
- 14.Jung SW, Kim MJ, Park SH, Joo CK. Multifocal corneal ablation for hyperopic presbyopes. J Refract Surg. 2008; 24(9):903–910. Link, Google Scholar
- 15.El Danasoury AM, Gamaly TO, Hantera M. Multizone LASIK with peripheral near zone for correction of presbyopia in myopic and hyperopic eyes: 1-year results. J Refract Surg. 2009; 25(3):296–305. Link, Google Scholar
- 16.Reinstein DZ, Archer TJ, Couch D. Accuracy of the WASCA aberrometer refraction compared to manifest refraction in myopia. J Refract Surg. 2006; 22(3):268–274. Link, Google Scholar
- 17.Waring GO. Standard graphs for reporting refractive surgery. J Refract Surg. 2000; 16(4):459–466. Erratum in J Refract Surg. 2001;2017:following table of contents. Medline, Google Scholar
- 18.Reinstein DZ, Waring GO. Graphic reporting of outcomes of refractive surgery. J Refract Surg. 2009; 25(11):975–978.
10.3928/1081597X-20091016-01 Link, Google Scholar - 19.Waring GO, Reinstein DZ, Dupps WJ, Standardized graphs and terms for refractive surgery results. J Refract Surg. 2011; 27(1):7–9. Link, Google Scholar
- 20.Wachler BS, Krueger RR. Normalized contrast sensitivity values. J Refract Surg. 1998; 14(4):463–466. Link, Google Scholar
- 21.Thibos LN, Applegate RA, Schwiegerling JT, Webb R. VSIA Standards Taskforce Members. Vision science and its applications. J Refract Surg. 2002; 18(5):S652–S660. Link, Google Scholar
- 22.Miranda D, Krueger RR. Monovision laser in situ keratomileusis for pre-presbyopic and presbyopic patients. J Refract Surg. 2004; 20(4):325–328. Link, Google Scholar
- 23.Yilmaz OF, Bayraktar S, Agca A, Yilmaz B, McDonald MB, van de Pol C. Intracorneal inlay for the surgical correction of presbyopia. J Cataract Refract Surg. 2008; 34(11):1921–1927.
10.1016/j.jcrs.2008.07.015 Crossref Medline, Google Scholar - 24.Seyeddain O, Hohensinn M, Riha W, Small-aperture corneal inlay for the correction of presbyopia: 3-year follow-up. J Cataract Refract Surg. 2012; 38(1):35–45.
10.1016/j.jcrs.2011.07.027 Crossref Medline, Google Scholar - 25.Mulet ME, Alio JL, Knorz MC. Hydrogel intracorneal inlays for the correction of hyperopia: outcomes and complications after 5 years of follow-up. Ophthalmology. 2009; 116(8):1455–1460.
10.1016/j.ophtha.2009.05.019 Crossref Medline, Google Scholar - 26.Bouzoukis DI, Kymionis GD, Limnopoulou AN, Kounis GA, Pallikaris IG. Femtosecond laser-assisted corneal pocket creation using a mask for inlay implantation. J Refract Surg. 2011; 27(11):818–820.
10.3928/1081597X-20110706-01 Link, Google Scholar - 27.Bouzoukis DI, Kymionis GD, Panagopoulou SI, Visual outcomes and safety of a small diameter intrastromal refractive inlay for the corneal compensation of presbyopia. J Refract Surg. 2012; 28(3):168–173.
10.3928/1081597X-20120124-02 Link, Google Scholar - 28.Chan E, Mahroo OA, Spalton DJ. Complications of cataract surgery. Clin Exp Optom. 2010; 93(6):379–389.
10.1111/j.1444-0938.2010.00516.x Crossref Medline, Google Scholar - 29.The Royal College of Ophthalmologists. Cataract Surgery Guidelines: Septemenber2010. http://www.rcophth.ac.uk/core/core_picker/download.asp?id=544. Accessed July 9, 2012. Google Scholar
- 30.Fitting A, Menassa N, Auffarth GU, Holzer MP. Effect of intrastromal correction of presbyopia with femtosecond laser (INTRACOR) on mesopic contrast sensitivity [German] [published online ahead of print July 5, 2012]. Ophthalmologe. doi: Google Scholar
