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Presby-LASIK accurate, safe at 1 year in multicenter study
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LONDON — Presby-LASIK is a safe, effective option for restoring near vision in young presbyopic patients, according to the results of a multicenter study by Canadian investigators.
"Patients regain near vision without giving up distance focus, and most of them achieve complete spectacle independence," said W. Bruce Jackson, MD, who presented the study results here at the European Society of Cataract and Refractive Surgeons meeting.
Dr. Jackson presented 1-year follow-up data for 93 eyes of 56 hyperopic patients. The mean age of the patients was 55 years.
Presby-LASIK can be performed using several ablation profiles, Dr. Jackson noted. In this study protocol, the central cornea was shaped for near vision and the periphery for distance vision, he said.
Most patients were treated bilaterally. Surgeons used either the Amadeus microkeratome or the IntraLase femtosecond laser to create the flap, and the Advanced Medical Optics Visx Star S4 WaveScan was used for ablation in all cases.
Preoperatively, mean sphere was +1.67 D and mean cylinder was +0.43 D. At 1 year, all patients achieved 20/25 or better distance visual acuity and J3 near acuity unaided. In addition, 85% achieved 20/25 at distance with J1 at near, and 80% were within +0.5 D of emmetropia, Dr. Jackson said.
Loss of contrast sensitivity was within normal limits. Because the ablation profile created a more prolate central cornea, there was a change in spherical aberration from positive to negative. Coma increased slightly but was stable over time.
Most patients were spectacle independent, and some used glasses occasionally.
"Patient satisfaction was extremely high; they were really delighted with their results. A few of them said they would like to improve near vision even further. Those who felt that distance vision was not as sharp as it was preoperatively were told they could be re-treated for distance vision but would lose some near vision. None of them wanted to go ahead with that," Dr. Jackson said.
Follow-up in the study is ongoing, he said.
"Presby-LASIK is a really good alternative for young presbyopes with low refractive errors who don't want intraocular surgery," Dr. Jackson concluded. "In pseudophakic patients who have a residual refractive error it could be used to improve both distance and near vision."
Results, he added, should improve further with a new ablation profile that provides better registration and centration.