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Femtosecond laser presbyopia correction yields visual stability up to 2 years
More than half of patients required reading glasses in low light conditions, but overall patient satisfaction exceeded 90%.
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A flapless femtosecond laser intrastromal presbyopia procedure significantly improved near vision and resulted in a high patient satisfaction rate, according to a study.
Claire Hartnett, MD, discussed 2-year visual and functional outcomes of the IntraCor procedure at the American Society of Cataract and Refractive Surgery meeting in Chicago.
“IntraCor is an intrastromal procedure performed with a femtosecond laser which results in a defined change in central corneal curvature and changes the refractive power of the cornea,” Hartnett said. “The results showed stability at 24 months. We feel that IntraCor offers a very good option for presbyopic correction in the future.”
The IntraCor procedure is performed exclusively with the Technolas 520F femtosecond laser (Technolas Perfect Vision).
The prospective study, conducted in Dublin, Ireland, had strict inclusion criteria, Hartnett said.
“For instance, the distance refraction of the patients eligible must be between 0 D to 1 D spherical equivalent. They also have minimum astigmatism, the only cylinder allowed a maximum of 0.5 D and a pachymetry reading of 500 µm,” she said.
The study included 67 eyes of 67 patients with a mean age of 52 years who underwent the IntraCor procedure in the nondominant eye.
Mean preoperative unaided near visual acuity was N18, with a mean required near addition of 2.1 D. Mean preoperative refraction was 0.34 D.
Study results showed that mean uncorrected near visual acuity at 6 weeks after surgery was N5.
“This is a dramatic improvement,” Hartnett said. “At 12 months postoperatively, 91% of our patients were spectacle independent, reading N8 or smaller, in natural lighting conditions. At 24 months, we note the stability of these results with a mean of N5.”
However, 9% of patients read at N5 to N10 and needed reading glasses; 60% of patients needed reading glasses in low lighting conditions.
The procedure yielded a mean myopic shift of 0.66 D at 6 months. The shift diminished to 0.62 D at 12 months and 0.54 D at 24 months.
“There is certainly a dramatic shift in the first few months but it gradually decreases over time,” Hartnett said.
The myopic shift spurred a reduction in distance visual acuity; data showed a mean loss of one logMAR line at 12 months. Sixteen percent of patients were aware of diminished distance visual acuity; 16% lost two lines and 6% lost three lines.
Results showed no loss of binocular depth perception or stereopsis. There was significant steepening of the central cornea 1 day after surgery but it diminished gradually at 6 months and 12 months.
Investigators saw no evidence of corneal ectasia at 24 months and endothelial density decreased 2.09% over 24 months.
Postoperatively, 28% of patients reported visual complications such as glare and halos, but the phenomena were visually insignificant.
The overall patient satisfaction rate was 91% despite diminished distance visual acuity and visual phenomena. – by Matt Hasson