Femtolasik In Adult Patient With Hyperopia, Mixed Astigmatism, And Anisometropic Amblyopia As A Solution For Improving Stereovision And Near Visual Function

The procedure aimed to transition from unstable binocular function to stable binocular vision, enabling the development of gross stereopsis. Additionally, it sought to improve near visual function, progressing from an inability to read to achieving the ability to read on a near vision chart.

The study utilized a near vision chart and a distance vision chart to assess visual acuity at different focal distances. Stereoscopic tests were conducted to evaluate depth perception, including the Schober test and a binocularity test to assess binocular vision function. Duochrome test was performed to determine accommodative balance. The vision correction procedure was performed using a femtosecond laser to ensure precise refractive adjustment.

A 33-year-old female came with the following refractive status:best-corrected distance visual acuity(BCDVA) in the right eye(OD) was 1.0 and in the left eye(OS) was 0.04/0.2 sph +5.75, cyl -7.25, ax 170. At 33 cm, the patient was unable to read the 10th text line on the near vision chart.Binocularity assessment revealed monocular vision with a tendency toward simultaneous perception.Intraocular pressure(IOP) was 13 mmHg in OD and 14 mmHg in OS via pneumotonometry.Central corneal thickness(CCT) was 626 µm in OD and 640 µm in OS. Axial length(AL) was 23.65 mm in OD and 22.88 mm in OS. An adaptation-based subjective correction was prescribed, considering full duochrome balance, with follow-up scheduled at three months for dynamic observation. The patient underwent pleoptic therapy. Near visual function improved to 0.3, while maximum corrected distance visual acuity (CDVA) reached 0.3.The FemtoLASIK was proposed to stabilize and enhance visual performance. The patient was psychologically well-prepared and motivated for the procedure.

Postoperative Outcome. Following the procedure, the patient reported no diplopia, with near visual acuity maintained at 0.3 and CDVA at 0.3. Stable binocular vision was established, with the emergence of gross stereopsis. IOP remained within normal limits, and residual CCT was 570 µm. Subjective evaluation and psychological assessment were positive, with the patient expressing satisfaction with the outcome. Dynamic follow-up at 6 months: stable.

Take-Home Messages. Individualized approach is key: personalized refractive correction, including adaptation-based subjective refraction, plays a crucial role in optimizing visual outcomes. The FemtoLASIK can be an effective solution for improving binocular function and stereopsis in patients with complex refractive errors. Psychological readiness is essential for successful outcomes, ensuring patient satisfaction and adaptation post-surgery. Postoperative stability: the absence of diplopia, maintained near and distance vision, and improved stereovision highlight the importance of a structured approach to both pre- and postoperative care.