LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform.
To evaluate the monocular and binocular outcomes of LASIK for a micro-monovision protocol for the correction of hyperopic astigmatism and presbyopia.



A prospective non-comparative case series included 258 eyes of 129 consecutive patients with hyperopic astigmatism and presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the Carl Zeiss Meditec MEL80 excimer laser. The target refraction was piano for distance eyes (dominant eye) and between -1.00 and -1.50 diopters (D) for near eyes. Patients were followed for 1 year.



Mean attempted spherical equivalent refraction (SE) correction was +2.54+/-1.16 D (range: +0.25 to +5.75 D). Mean attempted cylinder was -0.52+/-0.49 D (range: -0.00 to -3.25 D). Median age was 56 years (range: 44 to 66 years). Median follow-up was 12.5 months (range: 3.3 months [early retreatment] to 18.2 months). The retreatment rate was 22%. Outcome measures after all treatments were as follows. Mean deviation from the intended SE correction was +0.09+/-0.48 D, with 79% of eyes within +/-0.50 D and 95% within +/-1.00 D. The cylinder correction ratio was 1.23+/-0.63 and the error ratio was 0.67+/-0.65. Of the distance eyes, 86% achieved uncorrected visual acuity of 20/20 and 100% achieved 20/40. Binocularly, 95% of patients achieved 20/20 and 100% achieved 20/40. Eighty-one percent of patients could read J2 and 100% could read J5. Binocularly, 95% of patients achieved 20/20 and could read J5. No eyes lost 2 or more lines of best spectacle-corrected visual acuity. A statistically significant increase was noted in contrast sensitivity at 3 and 6 cycles per degree (cpd), with no reduction at 12 and 18 cpd. The average change in refraction between 3 months and 1 year was +0.11+/-0.36 D with a change of >1.00 D in 2.6% of eyes.



This hyperopic micro-monovision protocol was a well-tolerated and effective procedure for treating patients with presbyopia in moderate to high hyperopia with corrections ranging up to +5.75 D. Contrast sensitivity was improved and the distance vision of near eyes was found to contribute positively to binocular distance vision compared to distance eyes monocularly.
Reinstein
Dan Z
DZ
London Vision Clinic, London, UK. dzr@londonvisionclinic.com
Couch
Darren G
DG
Archer
Timothy J
TJ
D000328:Adult; D000368:Aged; D001251:Astigmatism / Q000503:physiopathology / Q000601:surgery*; D019781:Corneal Topography; D023882:Dominance, Ocular / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000503:physiopathology / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ / Q000295:instrumentation / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011305:Presbyopia / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012086:Reoperation; D015348:Vision, Binocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology