Barraquer Lecture: Hyperopic LASIK stable with long follow-up

CHICAGO — With follow-up of 5 to 8 years, LASIK correction of hyperopia and hyperopic astigmatism was accurate and stable, according to this year’s Barraquer Lecturer.

Carmen Barraquer, MD, focused on the challenges of hyperopia correction facing refractive surgeons in delivering the lecture named for her father, José Barraquer, here at the American Academy of Ophthalmology meeting.

Dr. Barraquer reminded attendees how much her father contributed to the field of ophthalmology, and she said she was deeply honored to deliver the lecture named for him.

“My father developed more than 20 original techniques for refractive surgery. He designed more than 30 instruments and wrote three books on keratophakia and keratomileusis,” she said.

The advent of LASIK “has allowed us to make a keratome evolution,” she said

Dr. Barraquer discussed the results of a retrospective study, with follow-up of 5 to 8 years, of hyperopia and hyperopia with astigmatism in young patients. The study included 74 eyes of 41 patients who ranged in age from 8 to 26 years, she said.

The Schwind excimer laser was used in the study, with an optical zone size of 6.5 mm to 7 mm for all eyes.

The average preoperative refractive error was +5.46 D, and average postoperative refractive error was +0.82 D, Dr. Barraquer said. She noted that these results were stable over the course of follow-up.

To further analyze how hyperopes responded to the refractive laser treatment, Dr. Barraquer divided the patients into three groups: low, moderate and high hyperopia. The low hyperopia group included 19 eyes with a preoperative error of +1.25 to 3 D. The moderate group included 38 eyes with a preop error of +3 D to +5.99 D. The high hyperopia group included 17 eyes with a preop error of +6 to +8.25 D.

In the low hyperopia group, 90% were within 0.5 D of emmetropia after surgery. In the moderate group, 82% were within 0.5 D of emmetropia, and in the high hyperopia group 30% were within 0.5 D of emmetropia. All patients were within 1 D of emmetropia, Dr. Barraquer said.

Almost all eyes in the moderate hyperopia group (97%) had unchanged uncorrected visual acuity postoperatively, while 95% of the low hyperopia group and 88% of the high hyperopia group had unchanged UCVA. Best corrected visual acuity remained unchanged in 95% of the low group, 94% of the moderate group and 65% of the high hyperopia group, Dr. Barraquer said.

She recommended the use of a 6.5 mm optical zone for young patients and 7 mm for adults.

She cautioned surgeons “not to mistake hyperopia for presbyopia” in adults.

In introducing Dr. Carmen Barraquer, James J. Salz, MD, said she has “made a significant contribution in refractive surgery and exemplifies the character of Dr. José Barraquer.”