Incidence And Risk Factors Of Accommodative Disorders After Laser-Assisted In Situ Keratomileusis For Moderate To High Hyperopia Correction

Laser vision correction (LVC) for hyperopia might sometimes cause unsatisfied patients with their uncorrected distance visual acuity. Commonly, these complains are secondary to a residual refractive error, but not so infrequently they are present due to binocular visual alterations, such as accommodative spasms. The literature about this issue is scarce, but it is relevant to find possible factors that may predispose a particular patient to develop this alteration and be able to inform them about this risk preoperatively. Our goal is to report the incidence of patients with accommodative spasms after LVC for moderate to high hyperopia with LASIK and also look for specific risk factors that may favor the appearance of this disorder.

Vissum (Miranza Group), Alicante, Spain.

Monocentric retrospective study that included all patients that underwent LASIK treatment for moderate to high hyperopia between 2016 and 2022 who presented a minimum follow-up of 6 months after surgery. We classified the severity of the accommodative disorder/accommodative spasm according to the degree of myopic spherical refractive defect at 3 months, as long as its positivizes after cycloplegia, into mild (≥ -0.25, < -1 diopters (D)), moderate (≥ -1 , < -1.75 D) and severe (≥ -1.75 D) . Both preoperative and intraoperative variables were recorded in order to determine the factors involved in the occurrence of this disorder. 

A total of 160 eyes were included. At 3 months after surgery, 21.83% (n=35) of the patients presented an accommodative disorder, 26 patients presented a mild disorder, 6 a moderate disorder and 3 a severe disorder. The group with the highest mean age was that of patients with severe disorder (37 ± 10 years). The mean preoperative UDVA was 0.55 ± 0.36, 0.55 ± 0.32 and 0.1 ± 0.05 in the mild, moderate and severe disorder groups, respectively. The group with the highest pre-surgical mean spherical refractive defect was the group of patients with severe disorder (4.5 ± 1.89 D), in addition this group presented the highest pre-surgical mean latent hyperopia, being 0.83 ± 0.29 and the highest values of treatment with Excimer laser 5.25 ± 1.64 D.

The presence of accommodative disorders after Laser-Assisted In Situ Keratomileusis for moderate to high hyperopia was higher in patients with older age, lower uncorrected visual acuity, higher pre-surgical spherical refractive defect and higher rate of latent hyperopia.