Femtosecond Laser-Assisted In Situ Keratomileusis For The Treatment Of Moderate To High Hyperopia

Despite currently available scientific evidence by using femto-LASIK and modern excimer laser platforms for the correction of hyperopia up to +7D, LASIK still remains unpopular among a majority of refractive surgeons. The diffusely established (and not supported by evidence) conception that LASIK is not a reliable treatment method for hyperopia over +3.5/4D is actually forcing the indication of refractive lens exchange (RLE) with multifocal IOL implantation for young non-presbyopic patients with hyperopia. Our goal is to specifically report the real modern outcomes of femto-LASIK for the correction of moderate-to-high hyperopia (≥3.50 and ≤6.50D), excluding confusing factors of previous evidence as low or very high hyperopia.

Vissum (Miranza Group), Alicante, Spain

Monocentric retrospective case series study. Visumax-500kHz femtosecond-laser, and Amaris-750 excimer-laser were used. Eyes with at least 6-months of follow-up were included. 36-month data was collected when available. Primary outcome measure was short term efficacy and safety. Secondary outcome measure was long term stability. Inclusion criteria were manifest hyperopia ≥3.50 and ≤6.50D, cylinder correction up to 5.5D, latent hyperopia ≤1.25D with a maximal cycloplegic hyperopia of +7.00D, expected postoperative steepest keratometry (K2) <50D. Target refraction was plano in all eyes included.

Six-month data of 92 eyes was collected (68 eyes at 36 months). Mean age was 34.6±10.4 years. Mean treated sphere was 4.69±0.87. Efficacy index was 0.91 and 0.90 at 6 and 36 months respectively. Safety index was 1.00. UDVA was 20/20 or better in 72%, postop spherical equivalent within 0.5D in 80% (93% within 1D), and loss of one line of CDVA occurred in 13% (2 or more lines in 0%). Gain of 1 or more CDVA lines occurred in 17%. A slight but significant regression was observed at 36 months. Postoperatively, 21.73% required flap lift for laser enhancement, and 11.95% an orthoptic visual rehabilitation due to accommodative disorders.

Modern LASIK provides good efficacy and safety in the management of moderate to high hyperopia (up to +6.5D), with levels that should at least make refractive surgeons reconsider the prescription of RLE for young patients without presbyopia according to the different invasiveness among both procedures and their long term implications. We have demonstrated (with Amaris 750 excimer laser) better results than previous literature by only eliminating the interference induced by those treated patients where very high hyperopia was targeted (> 6.5D). The risks for requiring postoperatively a refractive enhancement or an orthoptic visual rehabilitation (due to ciliary spasm) are still relevant and need to be discussed with patients preoperatively.