Visual Rejuvenation Of Dynamic Range Of Focus Using Laser Scleral Microporation (Lsm) In Emmetropic Presbyopes

To evaluate Dynamic Range of Focus (DRoF) after Laser Scleral Microporation (LSM) in Presbyopic Eyes demonstrated as improved uncorrected near visual acuity, distance corrected near acuity, and reduction in add power required at 40 cm.

Asian Eye Institute

54 eyes of 27 patients were treated using a 2.94um  Er:YAG laser to create a matrix of 255um microporations in 4 oblique quadrants of each eye in 5 critical zones of the sclera.  Subjects above 47yrs of age demonstrating at least a +1.5D add with 20/50 or worse DCNVA were included. The aim of LSM is to uncrosslink scleral microfibrils to decrease biomechanical stiffness. The goal is improving biomechanical efficiency of the ciliary muscles to rejuvenate the accommodative mechanism restoring Dynamic Range of focus (DRoF).Visual outcomes were assessed using the EDTRS logMAR charts with and without correction at distance, 60cm and 40cm.  The NAVQ standardized questionnaire was used to assess improvement in Quality of Life (QOL).  

LSM demonstrated a rejuvenation of DRoF by improving uncorrected monocular UDVA, UIVA, UNVA  from 0.02, 0.18 and 0.43 preoperatively to -0.02, 0.04 and 0.21 at 6 months respectively postoperatively. At 12 months, monocular UDVA, UIVA and UNVA were –0.02, 0.08, and 0.27 respectively.   DCIVA, DCNVA improved from 0.16 and 0.46 to 0.06 and 0.24 respectively postoperatively with no reduction in distance vision at 12 months. Unaided monocular visual acuity was not significantly different from baseline at 12 months postoperatively.  Refractive power required to read letters at the logMAR 0.00 level dropped from 2.03D (mean) to 1.15D (mean) at 6 months post-operatively, and 1.43D (mean) at 12 months post-operatively.  

Early results suggest LSM to be a safe and effective procedure for restoring  DRoF in presbyopes. Early results also suggest that LSM can improve intermediate and near visual acuity without touching the visual axis and without comprising distance vision while making a substantial difference in the QOL of presbyopesData collection is ongoing.