Assessing Quality Of Life After Binocular Vision Restoration With Bilateral Laser Scleral Microporation

The study investigates the impact of Laser Scleral Microporation (LSM) on binocular vision restoration and functional visual performance, binocular summation, and Health-Related Quality of Life. Additionally, the study investigates the impact of LSM on binocular vision restoration and functional visual performance. Understanding binocular summation and fusion in presbyopia progression is critical to assessing LSM’s effectiveness in enhancing near vision and maintaining binocular single vision.  

Study was a prospective, IRB-registered pilot trial at Asian Eye Institute, Philippines, adhering to the Declaration of Helsinki for ethical medical research. Participants gave informed consent, ensuring voluntary participation and understanding of the study’s objectives, procedures, and risks. The study followed good clinical practice (GCP) guidelines,ensuring confidentiality and rigorous data collection to evaluate the safety and efficacy of Laser Scleral Microporation for presbyopia treatment

A prospective, single-arm clinical trial enrolled 94 eyes of 47 presbyopic patients (mean age, 52.8 ± 4.0 y) with demonstrated loss of DROF as defined by DCNVA at 40 cm ≥ 20/50; UDVA 20/40 or better. Eyes were free of ocular anomalies requiring a reading add ≥ +1.50 D. All subjects underwent bilateral LSM therapy to treat emmetropic presbyopia. Visual function was assessed usin, aberrometry, ETDRS charts, and pupillometry. The Near Activity Visual Questionnaire (NAVQ) measured Patient Reported Outcomes (PROMs), and the Binarmeter instrument measured binocular summation at baseline and post-LSM at one week, one month, 3, 6, 12, 18, and 24 months. The control group consisted of 60 healthy emmetropic subjects.

An 8-patient subset measured with the binarmeter demonstrated a 3×  binocular summation increase after one month, averaging 1.5× across the cohort (range: 32–70 cm²). At six months post-LSM, near vision improved from 0.4 logMar to 0.1 logMar (p> 0.05; SD +/- .03).  add power decreased from +2.25 to +.25 +/- +.05 (P>0.05;SD +/- 0.05). LSM significantly improved near (items 1-3), intermediate (items 4-7), and special circumstance ADLs (items 8-10) at 12 and 24 months. Functional limitations' emotional impact varied by lifestyle and gender. 

Binocular fusion loss reduces visual comfort in presbyopia, worsened by monocular treatments that disrupt binocularity. Compared to controls, binocular summation, depth perception, and stereoacuity improved, confirming LSM as an effective bilateral presbyopia treatment. 

LSM restores accommodation and binocular fusion, improving visual function, HRQoL, and depth perception. A threefold increase in binocular summation highlights its potential to enhance stereoacuity and overall vision. As a minimally invasive alternative, LSM improves near vision while preserving binocular summation. Longer follow-up studies with larger cohorts are needed to confirm these findings.