Changes to Corneal Aberrations and Vision After Monovision in Patients With Hyperopia After Using a Customized Aspheric Ablation Profile to Increase Corneal Asphericity (Q-factor).
OBJECTIVE
To evaluate the visual outcomes and fourth-order Zernike spherical aberrations induced with a customized change in corneal asphericity (ΔQ) correction of presbyopia combined with monovision for hyperopic patients.


METHODS
Consecutive hyperopic patients who underwent presbyopic LASIK between September 2013 and July 2014 were included. For the non-dominant eyes, the aspheric ablation profile associated with a myopic refraction was planned using the Custom-Q nomogram (Alcon Laboratories, Inc., Fort Worth, TX). Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), spherical equivalent refraction, ΔQ, and change in corneal spherical aberration coefficient (ΔC40) were analyzed. Postoperative data were collected at 1, 3, and 6 months.


RESULTS
Sixty-five patients were included. The mean age was 56.5 ± 5.7 years (range: 47 to 70 years). At the 6-month follow-up, the spherical equivalent refraction for non-dominant and dominant eyes was -1.07 ± 0.74 and 0.32 ± 0.55 diopters (D), respectively. The mean binocular UDVA was 0.01 ± 0.04 logMAR (range: -0.12 to 0.30 logMAR); 91% of patients achieved 20/20 or better binocular UDVA and 83% of patients had Jaeger 3 (Parinaud 4) or better binocular UNVA. The ΔQ for non-dominant and dominant eyes was -0.61 ± 0.15 and -0.33 ± 0.25, respectively, for a 6-mm pupil diameter and was significantly higher for non-dominant eyes (P < .0001). The achieved ΔC40was -0.49 ± 0.23 µm for non-dominant eyes (for a theoretical ideal value of -0.40 µm) and -0.30 ± 0.18 µm for dominant eyes. For non-dominant eyes, the attempted ΔQ (-0.60) was close to the achieved value (-0.61 ± 0.15).


CONCLUSIONS
For hyperopic patients, combining the customized corneal aspheric ablation profile with monovision is safe, effective, and reproducible, inducing intended changes in corneal spherical aberrations. [J Refract Surg. 2016;32(11):734-741.].
Romain
R
Courtin
Alain
A
Saad
Alice
A
Grise-Dulac
Emmanuel
E
Guilbert
Damien
D
Gatinel
D000368:Aged; D003315:Cornea / Q000503:physiopathology; D057108:Corneal Wavefront Aberration / Q000503:physiopathology*; D023882:Dominance, Ocular / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006956:Hyperopia / Q000503:physiopathology / Q000601:surgery*; D020731:Keratomileusis, Laser In Situ / Q000379:methods*; D054018:Lasers, Excimer / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D011305:Presbyopia / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000502:physiology*; D015348:Vision, Binocular / Q000502:physiology; D014792:Visual Acuity / Q000502:physiology*