Outcomes following varifocal LASIK for hyperopic presbyopia

Session Details

Session Title: Hyperopic corrections

Session Date/Time: Sunday 14/09/2014 | 16:30-18:00

Paper Time: 17:15

Venue: Boulevard B

First Author: : M.Rashid UK

Co Author(s): :    S. Daya   M. Espinosa-Lagana           

Abstract Details

Purpose:

To evaluate the safety and efficacy of Supracor™ (Technolas Perfect Vision GmbH) - an excimer laser in situ keratomileusis (LASIK) algorithm for the treatment of hyperopic presbyopia

Setting:

Centre for Sight, Hazelden Place, East Grinstead, West Sussex, United Kingdom

Methods:

A retrospective, interventional consecutive case series evaluation of 58 eyes of 32 hyperopic presbyopic patients who underwent Supracor™ treatment between June 2011 and June 2013. Inclusion criteria for the procedure included age ≥46 years, corrected distance visual acuity (CDVA) in each eye of 20/32 or better, a stable manifest refraction spherical equivalent (MRSE) between +0.75 D and +4.00 D, astigmatism ≤2.00 D, a difference between the MRSE and the cycloplegic refraction ≤0.75 D (latent hyperopia), and the ability to tolerate a near addition of ≥1.75 D were prerequisite. Uncorrected near visual acuity (UNVA) was recorded using a Jaeger reading card at 40, 60 and 80 cm. Corneal topography was performed with the Orbscan IIz system and Pentacam. Patients were required to have mean keratometry readings of 41.0 to 45.0 D and normal corneal topography. Wavefront aberrometry measurements and pupillometry were obtained with the Zywave II aberrometer. The multifocal excimer LASIK treatments were performed by a single surgeon. Patients were reviewed at 1 day, 1 week, and 1, 3, 6 and 12 months after surgery. Main outcome measures were safety, efficacy (uncorrected distance visual acuity and uncorrected reading ability), predictability, stability, patient satisfaction, and functioning at 12 months.

Results:

The mean age was 51 years (44-63 years). The mean preoperative MRSE was +1.03 D±0.69. The mean preoperative UDVA was 0.18±0.24 logMAR monocularly and 0.07±0.15 logMAR binocularly. At 12 months postoperatively, 100% of patients achieved binocular UDVA Snellen ≥20/20 and binocular UNVA Snellen ≥20/32. The mean postoperative keratometric power increased after treatment and remained stable up to 12 months postoperatively [F (3, 145) = 0.171, p=0.196]. The Supracor™ algorithm resulted in an overcorrection of SE refractive outcomes at all postoperative time points (R2=0.37 at 12 months). No patient had a hyperopic outcome at 12 months postoperatively and safety was maintained with 97.2% of eyes achieving CDVA of Snellen ≥20/20. Twenty-eight percent of eyes experienced a loss of ≥1 Snellen lines of CDVA and 22% gained ≥1 Snellen lines of CDVA. There were no intraoperative complications. The most common complaints in the postoperative period related to symptoms of tear film dysfunction. There were no spontaneous reports of glare or haloes by 12 months postoperatively. The median total HOA significantly decreased from 1.24μm preoperatively to 0.64μm postoperatively (p<0.001). Spherical aberration decreased from 0.19μm preoperatively to -0.07μm postoperatively (p<0.001). Only one patient had retreatment to enhance UCDV after Supracor™ treatment.

Conclusions:

Our experience of the Supracor™ algorithm has illustrated that this alternative pseudoaccommodative approach in the treatment of presbyopia is very effective in providing good uncorrected near visual outcomes. However, consistent with other studies, there is a compromise in UDVA. It has been suggested that UDVA can be improved with nomogram adjustment. Another alternative approach to improve UDVA would be to aim for emmetropia in the dominant eye and 0.25 D of myopic defocus in the nondominant eye after nomogram adjustment. Whatever approach is undertaken, it is clear that careful preoperative selection and counseling is required to ensure optimal outcomes and realistic patient expectations. Longer follow up, as demonstrated by our study, is mandatory to assess the stability of refractive results, visual acuity outcomes and retreatment rates.

Financial Interest:

One or more of the authors... receives nonNONEmonetary benefits from a company producing, developing or supplying the product or procedure presented.