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Six-month experience of presbyopia correction with a µ-monovision approach in surface ablation using multifocal bi-aspheric ablation profiles
Session Title: Presbyopia Correction
Session Date/Time: Monday 07/10/2013 | 16:30-18:15
Paper Time: 17:12
Venue: Emerald (First Floor)
First Author: : E.Eskina RUSSIA
Co Author(s): : P. Rybakoff
To evaluate the postoperative clinical outcomes in terms of binocular and monocular uncorrected visual acuities, visual quality, and change in higher-order-aberrations, among presbyopic patients that have underwent alcohol-assisted PRK treatments.
Prof. Erika N. Eskina, MD, Laser surgery clinic SPHERE, Moscow, Russia
12 presbyopic patients (24 eyes) (48±5 years, range 41 to 59) with distance refraction SEQ -5.5D to +4.5D and astigmatism up to 1.75D with presbyopic add 1.75D to 2.25D were analysed four myopic patients and eight hyperopic patients. PresbyMAX µ-monovision bi-aspheric treatments were planned with Custom Ablation Manager software and ablations performed using the SCHWIND AMARIS flying-spot excimer laser system (both SCHWIND eye-tech-solutions). Alcohol-assisted PRK with use of Mitomycin C post laser ablation has been carried out in all cases. Standard examinations, a preoperative multifocal soft contact lens trial, pre- and postoperative wavefront analysis as well as preoperative pupillometry (both SCHWIND SIRIUS), and contrast sensitivity testing (Astroinform ZEBRA N 3) were performed. Clinical outcomes were evaluated in terms of refractive outcome, visual acuity, wave aberration, and contrast sensitivity. Clinical outcomes of six months follow-up were analysed.
At the time of submission 3 months postoperative data have been completed. The myopic group (4 patients) showed spherical equivalent power of -0.18±0.53 in distance eye (DE) and -0.94±0.29 in near eye (NE). Residual cylinder refraction was -0.31±0.32 in DE and -0.56±0.11 in NE. Uncorrected distance visual acuity (UDVA) was 20/23±3letters in DE and 20/39±8letters in NE. 100% achieved 20/25 or better binocular corrected distance visual acuity (CDVA) and J2 or better binocular corrected near visual acuity (CNVA). Uncorrected near visual acuity (UNVA) demonstrated 0.12±0.06 logRAD in DE and 0.1±0.00 logRAD in NE. The hyperopic group (8 patients) showed spherical equivalent power of -0.96±0.77 in DE and -1.71±0.94 in NE. Residual cylinder refraction was -0.54±0.46 in DE and -0.51±0.27 in NE. UDVA was 20/37±9letters in DE and 20/48±12letters in NE. 100% achieved 20/25 CDVA and J2 or better CNVA. UNVA demonstrated 0.23±0.2 logRAD in DE and 0.11±0.05 logRAD in NE. In both groups, the targeted anisometropia of 0.75D (µ-monovision approach) between DE and NE was achieved. The corneal spherical aberrations changed from positive value preoperative to a more negative value postoperative as intended by the treatment planning software. Contrast sensitivity did not significantly change compared to preoperative levels
The PresbyMAX µ-monovision approach with target anisometropia of 0.75D between DE and NE was achieved exactly. Near visual acuity increases fast (from one week to one month) when performing PresbyMAX presbyopia correction in combination with alcohol-assisted PRK method. Distance visual acuity recovers more slowly and took up to 3 months in the presbyopic myopic group. Recovery (for distance) in the presbyopic hyperopic group seem to be even longer as these patients have still a more negative distance refraction after three months compared to the presbyopic myopic group. Presbyopia correction requires a careful examination before operation, with use of strict exclusion criteria and detailed explanation about visual recovery to the patient. Further study and longer follow-up period have to show the safety and effectiveness of corneal presbyopia correction with use of surface ablation technique.