Presbyopia treatments yielding positive results

Bogota, Colombia-Results from lengthening follow-up of patients who have undergone CustomVue (Advanced Medical Optics/VISX) peripheral excimer laser ablation indicate it is a safe and effective treatment for myopia and pure presbyopia. Also, initial results are encouraging regarding the benefit of iris registration for enhancing outcomes of wavefront-guided multifocal ablation to treat hyperopic presbyopia, said Gustavo E. Tamayo, MD.

Dr. Tamayo presented results from 25.8 months of follow-up for a pooled series of 34 patients with myopic presbyopia and 20 with pure presbyopia. The analyses showed the treatment substantially improved near visual acuity overall. Fourteen (70%) of the pure presbyopic patients lost 1 line of distance uncorrected visual acuity (UCVA) due to a –0.61-D myopic shift, but without any change in best-corrected visual acuity (BCVA). Among 34 hyperopic patients followed for an average of 10.7 months, 70.5% achieved simultaneous uncorrected near visual acuity of J1 and uncorrected distance visual acuity of 20/30 or better.

With all groups combined, a total of 13 eyes (15%) underwent re-treatment, including six eyes that had an enhancement to improve near vision and seven eyes that were re-treated for distance vision. However, safety has been excellent. There have been no cases of loss of BCVA, and while contrast sensitivity decreases initially, it returns to preoperative levels by 3 months.

Multifocal ablation results

"Multifocal ablation in which the center is treated for near vision and the periphery for distance for the treatment of hyperopic presbyopia is currently available in some countries, with the AMO/VISX excimer laser. However, with a completely opposite approach: periphery for near and center for distance, results demonstrate improvement for an entire series of hyperopic eyes treated with the new iris registration upgrade to the STAR S4 laser. We are finding the same good outcomes using iris registration as in the myopic group," he said.

The presbyopic treatment for patients with myopia and emmetropia is based on the theory that the dioptric power of the periphery of the cornea can be changed in order to focus the divergent rays into the fovea. In this technique, the central 5 mm of the cornea is treated for distance vision and the zone from 5 to 9 mm is treated for near vision. The center region treated for distance accounts for 60% of the treated area, explained Dr. Tamayo.

The 54 myopic and pure presbyopic patients had a mean age of 55.9 years (range, 50.4 to 64.1 years). Myopia preoperatively ranged from –1 to –6 D.

Preoperatively, with best correction, all eyes could see 20/25 or better at distance and more than 90% were able to see 20/20 or better. Postoperatively, distance visual acuity with best correction was 20/20 or better in all eyes, and the proportion able to see 20/15 or better increased from about 20% to 30%.

"Those results demonstrate the safety of this procedure," Dr. Tamayo said.

The outcomes for uncorrected near visual acuity (UCNVA) highlighted its efficacy. Preoperatively, UCNVA was J6 or worse in 20 (37%) of the 54 eyes, whereas postoperatively, all eyes could read J3 or better without correction. In addition, while near visual acuity with distance correction was J6 or worse in all eyes preoperatively, postoperatively it had improved to J5 or better in all eyes with 39 (72%) achieving J3 or better.

"This is the endpoint that tells us the treatment is effective," Dr. Tamayo said.

Contrast sensitivity resolves

Although there was an initial decrease in contrast sensitivity at all spatial frequencies, by 3 months the results had returned toward preoperative levels.