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PATIENTS undergoing multifocal ablations with the Visx Star3 system achieve accurate distance corrections accompanied by gains in near vision, according to Bruce Jackson MD of the Ottawa Eye Institute.

Dr Jackson will be presenting the latest results from two cohorts of ongoing clinical studies with the multifocal ablation approach at this year's annual meeting of the ESCRS in Munich.
In the first cohort, 12 eyes of six presbyopic subjects with both myopic and hyperopic refractions received multifocal ablations. The patients had a mean age of 54 years with a mean refractive spherical equivalent of +2.24 D, and had a mean add requirement of +2.29D.

Data now available from the one-year follow-up visits shows that all patients achieved 20/25 or better at distance. Some 90% of patients achieved J3 for near vision at one year, with 50% reaching J1. Overall, 90% of eyes were 20/40 or better for both distance and near vision, he noted.

Pre-operative best spectacle corrected visual acuity for distance was 20/16 or better in 58% of patients pre-treatment. This dropped slightly at one year postoperative, to 50%. Similarly, pre-op BCSVA for distance was 20/20 or better in 100% of patients, dropping to 90% at one year postoperative. No eye lost more than one line of BSCVA.
Dr Jackson commented that although the improvement for near vision wasn't quite as good as the researchers had hoped, patients did notice substantial improvement. Also, there seemed to be more improvement as time went on.

The second treatment cohort included eighteen eyes of hyperopic presbyopic patients who underwent a refined multi-focal LASIK treatment to correct both distance and near vision. Eight of those eyes underwent standard hyperopic LASIK treatment combined with the presbyopic profile, while 10 eyes were treated with a new wavefront guided multifocal ablation. Patients' average age was 55 years, with a mean MRSE of +1.54D.

At one week, 72% of all the patients in both treatment groups had a distance UCVA of 20/20 or better, compared to 86% at one month. At one week, 78% had a distance UCVA of 20/25, compared to 86% of patients at one month. All patients were 20/40 or better at both one week and one month.
The mean uncorrected near visual acuity was 20/25 or better (J1) in half of the patients, and 20/32 (J2) in 71%. The mean add at one month was +1.66D. At one month, seven percent of patients had a gain of one line, 64% had no change, and 21% had lost one line.

A total of 71% of eyes saw 20/40 near, and 20/25 distance.
Dr Jackson noted that patients tended to be a little bit myopic overall. The multifocal ablations decreased the patients' adds, but interestingly enough, not as much as would be expected based on their near vision results, he noted.
These initial results indicate that it is possible to achieve simultaneous distance and near vision correction with the VISX S3 LASIK platform, Dr. Jackson said.
The results of the studies undertaken to date support the notion that the VISX multifocal approach is more likely to benefit hyperopic than myopic individuals. As more patients are treated, the researchers will separate out the numbers and see whether there is indeed an advantage with the wavefront-guided system over regular hyperopic treatment.

"Hyperopes continue to have excellent distance vision but are able to get enough improvement with reading that they are thrilled with the results. When hyperopic patients get to presbyopic age, they can neither see distance nor near. If you give them distance, that's great but if you can give them some near too, that's terrific."
The new approach to presbyopia treatment attempts to steepen the central area of the cornea to provide a myopic region for near vision, while also targeting the peripheral optical zone targeted for emmetropia. The Visx WavePrint system is used to create the multifocal ablation profile.

Dr. Jackson has done preliminary work on presbyopic myopic patients, but the near results were not as good as was hoped for. The Canadian researcher is with the only research team using the patented VISX multifocal ablation profile in formal clinical studies for the treatment of presbyopia.
Researchers began considering the idea of multifocal LASIK following the appearance of anecdotal reports of the resolution of presbyopic symptoms following hyperopic ablation in older patients. Extensive topographic analysis of those patients provided enough data to design a clinical study.

Ramon Naranjo-Tackman MD conducted a feasibility study of the new approach in Mexico. He performed four unilateral treatments with up to one year of follow-up. He observed multifocal effects in these early cases, with no significant loss of best-corrected distance visual acuity.
The clinical numbers cited in this article were provisional and will be updated by Dr Jackson at the ESCRS conference.

W. Bruce Jackson, MD,
Ottawa Eye Institute
bjackson@ohri.ca

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