Presbyopic LASIK offers option for selected patients

"Patients with hyperopia seem to do better with this approach than those with myopia, and so far we have little data on its use in emmetropic eyes, but studies are ongoing," Dr. Jackson said at the refractive surgery subspecialty day meeting sponsored by the International Society of Refractive Surgery of the American Academy of Ophthalmology at the annual meeting.

"For now, however, it seems to offer a good alternative for young patients with presbyopia and low refractive errors who do not want intraocular surgery as well as for patients who have residual refractive errors after IOL implantation and who are seeking refractive correction and enhancement of near vision. We can look forward in the future to even better results with new ablation profiles and benefits of new technology for better registration and centration," said Dr. Jackson, who is professor and chairman of ophthalmology, University of Ottawa, Ontario, Canada.

His comments were based on results from a multicenter Canadian study that showed patients treated bilaterally with a customized hyperopic ablation (CustomVue, VISX) combined with a presbyopic central treatment achieved enhanced near vision while maintaining good outcomes for distance vision. The trial included 33 patients with hyperopia (mean age, 56 years). The eyes had a mean sphere of +1.65 D with a range up to +3.5 D and mean cylinder of +0.43 D with a range up to +1.5 D.

The procedures were performed using the S4 excimer laser (AMO/VISX) and Amadeus microkeratome (AMO/VISX). There were no nomogram adjustments or re-treatments in the series, and only 18 eyes had surgery using iris registration technology.

With follow-up available up to 12 months in some individuals, 100% of patients maintained 20/25 distance UCVA or better, while the proportion able to see 20/20 or better was around 70% to 78% early in follow-up and was increasing at 12 months. All patients were also able to read J3. However, there was a decrease over time in the proportion who had J1 near vision from 88% earlier in the follow-up to 63% at 12 months. That change may be explained by the change in mean MRSE over time; mean MRSE was close to plano early and increased to become slightly hyperopic at 9 and 12 months.

Contrast sensitivity dropped slightly after surgery, but had returned almost to preoperative levels by 12 months and was within the norms for the age-matched reference group.

Best spectacle-corrected visual acuity (BSCVA) at distance and near was decreased in a few patients, but in no eye was BSCVA worse than 20/25 minus 2 for distance or worse than J1+ at near. Wavefront evaluation of higher-order aberrations showed no change in coma, and spherical aberrations changed from positive to negative.

"We will need to collect data for more patients at 12 months to see if the wavefront outcomes are maintained," Dr. Jackson said.

Satisfaction high

Results of a questionnaire asking patients to compare their satisfaction with their uncorrected vision in different conditions with their preoperative best-corrected vision showed patients were quite satisfied overall with the sharpness and clarity of their vision. They also reported good satisfaction with vision at night and were happy with distance vision in daylight. Satisfaction with near vision in bright lights had decreased at 12 months compared with earlier assessments.

"Those results are consistent with the decrease at 12 months in the proportion of patients able to read J1," Dr. Jackson said.

One third of patients reported being spectacle-free for all reading and about half said they wore glasses some of the time to work at the computer. No one required correction for day driving, night driving, or any recreational activity.