Acuity, Wavefront, Stereo And Satisfaction Outcomes Of Supracor Transepithelial Phototherapeutic Keratectomy (Transprk) In Myopic Presbyopes

SUPRACOR is Bausch and Lomb’s proprietary presbyopic laser algorithm, licensed for use with the Teneo Model 2 excimer laser. Unlike laser algorithms that depend on the addition of spherical aberration and significant under-correction of the reading eye, SUPRACOR produces a central 3mm corneal zone of variable curvature, resulting in an extended depth of focus. Three modes are available: Mild, Regular, and Strong, providing near-addition values of +1.25 to +2.75. With a mini-monovision target, it is possible to retain good distance vision while preserving reading acuity and stereo vision. The purpose of this study was to determine the outcomes of SUPRACOR with TransPRK in myopic presbyopes.

This was a prospective, single-blind, single-centre study conducted at OasisEye Specialists, Malaysia. Twenty-seven presbyopic patients with myopia and/or astigmatism without prior surgery received bilateral TransPRK.

Twenty-seven consecutive patients (female, male) received TransPRK with PROSCAN aspheric profile (PP) in the dominant eye and SUPRACOR STRONG (SS) in the non-dominant eye. At baseline, mean ±standard deviation (SD) age was 43.6±5.3 years. Mean ±SD refractive error (S/C) was -3.79±2.52/-0.89±0.58. Dominant eyes received PROSCAN aspheric ablation (6.5mm optical zone) targeting plano, and the non-dominant eye received SUPRACOR STRONG targeting -0.50 centred on the pupil. Primary outcomes included binocular uncorrected distance(UDVA), intermediate(UIVA), and near(UNVA) visual acuity. Secondary outcomes included induced wavefront aberrations, distance and near stereopsis, spectacle independence and patient satisfaction.

At an average of 4.7 months postoperative, patients had mean binocular UDVA, UIVA (60cm), and UNVA (40cm) of -0.01±0.08, 0.01±0.10, and 0.06±0.16 logMAR, respectively. Mean monocular UDVA / UNVA for PROSCAN and SUPRACOR eyes were 0.04±0.12 and 0.16±0.15, respectively.

SUPRACOR induced less spherical aberration (0.11±0.49 µm) compared to PROSCAN (0.22±0.41 µm). 67% of patients achieved distance stereo outcomes of ≤120 arc-sec, and 77% of patients achieved near stereo outcomes of ≤63 arc-sec. There was no subjective loss of stereopsis.

87% of respondents were completely spectacle-independent for driving and intermediate tasks, with 80% reporting complete independence for small print. 80% reported ‘complete’ satisfaction with SUPRACOR.

The results of this study demonstrate that TransPRK with SUPRACOR in myopic presbyopes provides excellent continuous vision from distance to near.

Mini-mono vision provides a near add of +3.25 to +3.5 while retaining useful distance vision in SUPRACOR eyes. SUPRACOR induces minimal spherical aberration, consistent with refractive multifocality, as opposed to the extended depth-of-focus provided by induction of spherical aberration.

Surprisingly, results indicate that distance stereopsis was inferior to near stereopsis. This could be caused by the limited number of distance test plates compared to near test plates. Nevertheless, patients reported high satisfaction and spectacle independence, with no subjective impact on stereopsis.