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Micromonovision with increased spherical aberration effective for presbyopia
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Presbyopic LASIK with micromonovision and aspheric aberration patterns was proven safe and effective in a study, with no reduction of stereopsis and good quality of vision.
At the QuirónSalud University Hospital in Madrid, 50 presbyopic patients 40 to 55 years old were divided in three groups: those with refraction between +0.50 D and + 3.00 D, between – 0.50 D and – 3.00 D and greater than – 3.00 D up to – 6.00 D.
Preoperative astigmatism was between 0.00 D and 3.00 D. All patients underwent LASIK with the Mel 80 excimer laser (Carl Zeiss Meditec). The dominant eye was corrected for distance vision with a target refraction of + 0.50 D, and the nondominant eye was corrected for near with a target refraction between – 0.75 D and – 1.50 D. This method, also named Laser Blended Vision, combines a controlled increase of spherical aberration to enhance depth of field with micromonovision to achieve good binocular vision at all distances.
Binocular function was good, with only one patient losing two lines of corrected distance visual acuity. Stereopsis after surgery did not change in group 1 and 2 and even improved slightly in group 3. Contrast sensitivity was unaltered, with a slight improvement in group 2. Quality of vision as measured by the Optical Quality Analysis System improved in all eyes, with best results in group 1 and 2.
Retreatment was performed in four patients, three of whom were hyperopic, for surgical undercorrection that did not affect multifocality.
“We believe that the retreatment rate might be related to the presbyopic program because the system we used does not allow modifications. Also, the degree of refractive regression is usually greater in hyperopic treatments than in myopic treatments,” the authors wrote. – by Michela Cimberle
Disclosure: The authors reported no relevant financial disclosures.
Perspective
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Harry Green, OD, PhD, FAAO
As the population of the world lives longer, most of our patients spend approximately half of their lifetime (the more productive half, actually) in some stage of presbyopia. This growing population has fueled the development of any number of solutions, including presbyopic LASIK.
The strategy employed in this paper is a surgical corollary to “modified monovision” in multifocal contact lenses, where a micromonovision strategy is combined with low add powers in both eyes, which can very successfully provide good binocularity at all distances for presbyopic patients.
One interesting omission from this paper was a measure of postsurgical patient satisfaction. Although the objective measures in this study were comprehensive, we all know that every patient utilizes vision uniquely in their life activities, and patient satisfaction with the outcome is arguably the most important factor in LASIK.
Hopefully this latter point will be something that is incorporated into these types of studies in the future.
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