Presbyopic LASIK correction stable and safe at 1 year

Long-term results show safe, stable and satisfactory results for patients with hyperopia.

Multifocal presbyopic LASIK appears to be both safe and stable with at least 1 year of follow-up, according to an ongoing study.

At the American Society of Cataract and Refractive Surgery meeting, W. Bruce Jackson, MD, presented the latest results of his study, which includes a large group of patients treated with AMO/Visx Star S4 WaveScan treatments and followed for at least a year.

Dr. Jackson said he began working on the study with the AMO/Visx Star in 2001, when presbyopic treatments were on the horizon. He said this study provides a long-term, multicenter experience using the same procedures.

“What we really wanted to do with Visx was put in place a really controlled study to start to look at presbyopic treatments,” Dr. Jackson told Ocular Surgery News in a follow-up interview.

The treatments

W. Bruce Jackson

Having now treated a variety of myopic and hyperopic patients for presbyopia, Dr. Jackson said there was an obvious trend that hyperopes were faring better than myopes, causing him to concentrate on their treatments.

“Out of that initial group, the hyperopes did the best, as you might expect,” Dr. Jackson told OSN. “We centered on the hyperopes, and there was a period of time when we were doing a standard hyperopic treatment combined with the presbyopic ablation, and then everything moved to wavefront-guided and that’s what we did. That’s why this last cohort is all wavefront-guided.”

This study included 82 eyes of 49 hyperopic presbyopic patients from three centers. All of the eyes underwent standard bilateral LASIK hyperopic treatments with no nomogram adjustments or re-treatments.

“For the surgeon, there was no difference in the technique or in the postop follow-up or anything,” Dr. Jackson said. “The program itself put in the extra treatment pulses, and so it was no different than a wavefront-guided hyperopic treatment.”

Safe and effective

Dr. Jackson said although there were no surprises in the resulting data, the numbers support the notion of safe and effective presbyopic treatments with the Visx laser.

“I would say there were really no surprises from what we had learned all the way along,” he said.

At 1 year postop, 76% of the patients were 20/20, 91% were 20/25 and 100% were 20/40 or better when tested for monocular uncorrected distance vision. Binocularly, 100% of the patients were 20/25 or better.

For monocular near vision, 61% were J1, 85% were J3 and 91% were J5 or better. Like distance vision, the percentages improved when tested for binocular near vision: 88% were J1 and 100% were J3 or better.

In addition, both distance and near vision improved over time. Dr. Jackson said he could not fully explain this but suggested it may be due to neural adaptation.

“This is really the sweet spot,” Dr. Jackson said in his presentation. “At 12 months, 100% of the subjects can see 20/25 distance and J3 near, but 88% were at the 20/25 and J1 level.”

Dr. Jackson noted that some patients lost lines due to dry eye, and some coma was induced. No eyes were worse than 20/25 or J1, he said, and coma remained stable through the year.

Patient satisfaction

Dr. Jackson said in his presentation that patients were given questionnaires regarding their subjective satisfaction postoperatively.

“Overall visual sharpness and clarity, they were very happy with these results. They were happy with their distance vision in bright light,” he said. “When we came to their near vision in bright light, it decreased a little bit at 12 months. This was partly due to the fact that they were losing a little of their near vision as they became slightly hyperopic at 1 year.”

He added, “They were very happy with their night vision. They were happier than they were with their best corrected preop.”

Patients often went without spectacles, he said, although about half required glasses at some point for reading and slightly under half required them at some point for computer use.

“Many were functioning without any glasses whatsoever, and for most of their activities, they never did put on their glasses,” Dr. Jackson told OSN. “Others did find that they needed them for reading or for some computer work some of the time.”

Next step

Dr. Jackson said the study researchers are examining results and modifying their current research.

“There’s a couple things that we’re doing now in the next group that we’re treating,” he told OSN.

The first small change was derived from the observation that patients were slightly hyperopic – 0.14 D mean spherical equivalent – at the 12-month follow-up.

“From that point of view, the chances are they will go a little bit more hyperopic as they get older,” he said. “There’s a tendency to increase hyperopia slightly.”

To treat that, Dr. Jackson said they would be making a small adjustment to the dominant eye in order to add “a little extra” treatment for distance.

Patients, though, would “just love a little bit more near vision,” he said. To address that problem, Dr. Jackson said they were considering purposely overcorrecting by 0.5 D.

“The question is, is this truly a presbyopic correction? I’ve always looked at it as enhancing near vision. If you take our standard hyperopic treatment and then you look at what we’re doing, we’re really increasing the range,” Dr. Jackson said. “You’re not going to get a true presbyopic correction unless they’re really young and they have some of their own accommodation or you go to an IOL.”

For more information:

• W. Bruce Jackson, MD, can be reached at the University of Ottawa Eye Institute, 501 Smyth Road, Tower III, Room 3301, Ottawa, ON K1H 8L6, Canada; 613-737-8759; fax: 613-737-8374; e-mail: bjackson@ottawahospital.on.ca. Dr. Jackson is a paid consultant to Visx and has had research funded by the company.

• Katrina Altersitz is an OSN Staff Writer who covers all aspects of ophthalmology.