Restoration of bionocularity & visual system activity after laser scleral microporation
First Author: O.Rozanova RUSSIA
Co Author(s): R. Ang A. Hipsley L. Gualdi M. Jackson B. Hall
To clarify dynamic, self-regulating mechanisms of presbyopia and to evaluate a presbyopia therapy which aims to restore binocularity.
Subjects were enrolled in an early feasibility study to evaluate the safety and efficacy of the Laser Scleral Microporation (LSM) to restore binocularity.
Patients (n=10) with a range of refractive error without concomitant pathology were examined. The functional state of the visual system in monocular and binocular conditions was investigated using ultrasound biomicroscopy, Schleimpflug imaging, aberrometry, standard ETDRS charts, and pupillometry. Evaluation of the effects of the Laser Scleral Microporation (LSM) procedure on binocularity and stereopsis of 10 patients was also performed.
The decrease of accommodation in presbyopia is accompanied by marked changes in the lens and ciliary muscle, an increase of optical aberrations, changes in diaphragmatic function of the pupil, specific to each of the refractive groups. The shift of image focus zone in presbyopia is accompanied by suppression of binocular cooperation. The degree of binocular summation and stereopsis are reduced. Results from a prospective single arm clinical trial are offered for 10 patients over a 3 month follow up period of presbyopic patients who were treated with the LSM procedure. Area of binocular summation in these patients increased (p=0.03,Wilcoxon), and stereopsis improved as well approaching statistical significance at 3 months post operatively.
Disintegration of binocular interaction may be one of the key mechanisms of presbyopia formation. Unfortunately, most current surgical presbyopia treatments reduce binocular vision, increasing the risk for dissatisfaction post-operatively. An exception is LSM, a procedure that appears not only to restore accommodative function but also binocularity and stereopsis.
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