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New PresbyLASIK algorithms show satisfactory outcomes
Hyperopic and presbyopic treatment with the Technolas Teneo excimer laser from Bausch + Lomb, using two different algorithms in the dominant and nondominant eyes, showed safety, efficacy and stability at 24 months.
Eighty eyes of 40 patients were included in the retrospective study. After creating a flap with the VisuMax femtosecond laser system (Carl Zeiss Meditec), excimer laser treatment was performed using the Proscan algorithm for the distance dominant eye (target at 0 D, optical zone at 6.5 mm and nomogram at 100%) and the Supracor algorithm for the near dominant eye (target from 0 D to –0.5 D, optical zone at 6 mm and nomogram at 117%).
The treatment showed high efficacy, with 93% of the eyes achieving 20/20 or better binocular uncorrected distance visual acuity and 90% achieving J1.5 or better binocular uncorrected near visual acuity.
Regarding safety, at 24 months, approximately 18% of dominant eyes had no change in corrected distance visual acuity and approximately 83% gained one line. A loss of one line was reported in 50% of nondominant eyes. In terms of stability, a slight regression occurred between months 3 and 24, likely due to epithelium cellular changes. A change of +0.22 D was reported for the nondominant eye, and a change of +0.39 D was reported for the dominant eye.
“Refractive surgery for presbyopia has been one of the most discussed subjects in refractive ophthalmology,” the authors wrote. “Proscan surgery in the dominant eye and Supracor in the nondominant eye using the Teneo 317 algorithm demonstrated that the hyperopic presbyopic excimer laser surgery technique outcomes are reasonable after 24 months of follow-up.” – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to TopThe upshot of this study is that current ablative techniques such as the Supracor platform for addressing presbyopia can produce functional near vision in patients with hyperopic refractive error. In the presented study, authors reviewed the refractive performance of excimer ablation for distance in the dominant eye and a modified ablation pattern, the Supracor Teneo 317, for the creation of a near focal point in the nondominant eye. The data suggest this is a reasonable approach to creating near vision in the nondominant eye while preserving binocular uncorrected acuity.
While the excimer platform studied here is not approved for use in the United States, it lends confidence to current efforts to push corneal-based refractive surgery to expand options for presbyopia correction. This includes modified monovision approaches as well as multifocal ablation profiles.
This study is an excellent indication of the refractive accuracy of the procedure, which in my understanding creates a form of modified monovision by enhancing near in the nondominant eye. However, as with all refractive presbyopia corrections, clinicians will need to understand how this impacts patient function and visual satisfaction. Notably, the study reports excellent safety in the distance dominant eye, but 50% of nondominant eyes lost a line of corrected vision, presumably from the creation of multifocality in the uniquely aberrated cornea. This affords patients with much more functional near vision but at some sacrifice to monocular distance vision, and visual function and quality metrics will be needed to better understand how best to implement such technology.
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