Presbyopic LASIK using hybrid bi-aspheric micro-monovision ablation profile for presbyopic corneal treatments.

PURPOSE: To evaluate distance and near image quality after hybrid bi-aspheric multifocal central presbyLASIK treatments. DESIGN: Consecutive case series. METHODS: Sixty-four eyes of 32 patients consecutively treated with central presbyLASIK were assessed. The mean age of the patients was 51 ± 3 years with a mean spherical equivalent refraction of -1.08 ± 2.62 diopters (D) and mean astigmatism of 0.52 ± 0.42 D. Monocular corrected distance visual acuity (CDVA), corrected near visual acuity (CNVA), and distance corrected near visual acuity (DCNVA) of nondominant eyes; binocular uncorrected distance visual acuity (UDVA); uncorrected intermediate visual acuity (UIVA); distance corrected intermediate visual acuity (DCIVA); and uncorrected near visual acuity (UNVA) were assessed pre- and postoperatively. Subjective quality of vision and near vision was assessed using the 10-item Rasch-scaled Quality of Vision and Near Activity Visual Questionnaire, respectively. RESULTS: At 1 year postoperatively, 93% of patients achieved 20/20 or better binocular UDVA; 90% and 97% of patients had J2 or better UNVA and UIVA, respectively; 7% lost 2 Snellen lines of CDVA; Strehl ratio reduced by ∼-4% ± 14%. Defocus curves revealed a loss of half a Snellen line at best focus, with no change for intermediate vergence (-1.25 D) and a mean gain of 2 lines for near vergence (-3 D). CONCLUSIONS: Presbyopic treatment using a hybrid bi-aspheric micro-monovision ablation profile is safe and efficacious. The postoperative outcomes indicate improvements in binocular vision at far, intermediate, and near distances with improved contrast sensitivity. A 19% retreatment rate should be considered to increase satisfaction levels, besides a 3% reversal rate

Long-term Outcomes After LASIK Using a Hybrid Bi-aspheric Micro-monovision Ablation Profile for Presbyopia Correction

PURPOSE: To evaluate visual outcomes 6 years after hybrid bi-aspheric multifocal central laser in situ keratomileusis for presbyopia correction (PresbyLASIK) treatments. METHODS: Thirty-eight eyes of 19 patients consecutively treated with central PresbyLASIK were assessed. The mean age of the patients was 51 ± 3 years at the time of treatment with a mean spherical equivalent refraction of −0.57 ± 1.98 diopters (D) and mean astigmatism of 0.58 ± 0.57 D. Monocular corrected distance visual acuity (CDVA), corrected near visual acuity (CNVA), and distance-corrected near visual acuity (DCNVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), and uncorrected near visual acuity (UNVA) were assessed preoperatively and postoperatively for the dominant eye, non-dominant eye, and binocularly. Subjective quality of vision and near vision were assessed using the 10-item, Rasch-scaled, Quality of Vision (QoV) Questionnaire and Near Activity Visual Questionnaire (NAVQ), respectively. RESULTS: At 6 years postoperatively, mean binocular UDVA was 20/18 ± 4 and mean binocular UNVA and UIVA were 0.11 ± 0.13 and −0.08 ± 0.08 logRAD, respectively. Spherical equivalent showed a slow hyperopic drift of +0.10 D per year with refractive astigmatism stable from 6 weeks postoperatively. Defocus curves showed an improvement of 0.4 Snellen lines at best focus from 1 to 6 years of follow-up, reaching preoperative levels. Compared to the preoperative status, the corneal and ocular spherical aberrations (at a 6-mm diameter) decreased and were stable from 3 months of follow-up. Questionnaires revealed a postoperative unaided QoV score comparable to preoperative scores and with an improved postoperative unaided NAVQ score compared to preoperative scores with best correction. CONCLUSIONS: Presbyopic treatment using a hybrid bi-aspheric micro-monovision ablation profile is safe and efficacious even after 6 years postoperatively. The postoperative outcomes indicate improvements in binocular vision at far, intermediate, and near distances. An 8% re-treatment rate should be considered to increase satisfaction levels, including a 3% reversal rate

Factors Associated With Ocular Cyclotorsion Detected by High-Speed Dual-Detection Eye Tracker During Single-Step Transepithelial Photorefractive Keratectomy.

To determine demographic, surgical, and preoperative visual factors affecting the level of static and dynamic cyclotorsion (SC and DC) in eyes undergoing single-step transepithelial photorefractive keratectomy (TransPRK). In this cross-sectional study, 386 patients with different types of refractive errors scheduled for single-step TransPRK were enrolled. A comprehensive profile of personal, optic, and visual characteristics of patients as surgical parameters were collected. Statistical modeling was used to explore correlates of SC and DC before and during the refractive procedure, respectively. There was no difference in various indices of SC and DC between right and left eyes. Lower age (beta = -0.20), uncorrected (beta = -0.99) and corrected (beta = -0.72) visual acuities, and keratometry (beta = -0.09) were significantly associated with higher ranges of DC during the laser ablation procedure. Worse mesopic contrast sensitivity (beta = 0.24) and higher (beta = 0.002, left eyes) or lower (beta = -0.002, right eyes) kappa locus also showed significant associations with a higher range of DC. In cases of SC before the procedure, amount (beta = 0.46) and axis (beta = -0.003) of the astigmatism demonstrated notable associations. Through comprehensive modeling, age, visual axis indices, visual acuity, and contrast sensitivity were found to be the main factors significantly associated with dynamic ocular globe cyclotorsions during single-step TransPRK. This could help identify eyes at higher risk of cyclotorsion and its potential complications in refractive surgery. [J Refract Surg. 2018;34(11):736-744.]