J Korean Ophthalmol Soc.  2012 Jan;53(1):11-19. 10.3341/jkos.2012.53.1.11.

LASIK for Myopia with Presbyopia Using the Aspheric Micro-Monovision Technique

• Bae K
• Keum JE
• Chung TY
• Chung ES

• KMID: 2215240
• DOI: http://doi.org/10.3341/jkos.2012.53.1.11

Abstract

PURPOSE
To evaluate the efficacy, safety, and satisfaction of patients who underwent the aspheric micro-monovision protocol for the correction of myopia with presbyopia.
METHODS
A retrospective, noncomparative study included 40 eyes of 20 consecutive patients with myopia and presbyopia who were treated with LASIK-induced micro-monovision. Monocular and binocular visual outcomes of uncorrected and best-corrected distance, intermediate, and near visual acuity were measured. Depth of focus, spherical aberration, stereopsis and satisfaction were evaluated before surgery and 3 months after surgery.
RESULTS
Mean patient age was 48.7 years. Monocular uncorrected distance visual acuity was 0.8 in 94% of dominant eyes, and monocular uncorrected near visual acuity was J3 in 94% in non-dominant eyes. Binocular uncorrected near visual acuity was J2 in 94% and J5 in 100% of dominant and non-dominant patient eyes, respectively. Binocular uncorrected distance visual acuity was 1.0 in 100% of patients, and binocular uncorrected near visual acuity was J2 in 94% of patients. Our results showed a significant improvement in depth of focus and a positive shift in spherical aberration in dominant eyes; however, there were no significant changes in the non-dominant eyes. There was no change in stereopsis or contrast sensitivity at any of the tested spatial frequencies. Satisfactory scores were achieved in all eyes.
CONCLUSIONS
The aspheric myopic micro-monovision protocol was well-tolerated, stable, and effective for treating patients with presbyopia in myopic astigmatism.

Keyword

Depth of focus; LASIK; Monovision; Myopia; Presbyopia

MeSH Terms

Astigmatism
Contrast Sensitivity
Depth Perception
Eye
Humans
Keratomileusis, Laser In Situ
Myopia
Presbyopia
Retrospective Studies
Telescopes
Visual Acuity

Figure

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  Figure 1. Histogram showing the accuracy to the intended spherical equivalent refraction 3 months after treatment.

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  Figure 2. Cumulative histogram for the distribution of the de-focus equivalent 3 months after treatment.

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  Figure 3. Changes of binocular and monocular uncorrected distant visual acuity 3 months after treatment. (A) Uncorrected distant visual acuity, (B) Uncorrected near visual acuity, (C) Uncorrected intermediate visual acuity. D = dominant eye; ND = non-dominant eye; B = binocular.

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  Figure 4. Combined distance and near binocular uncorrected distance visual acuity 3 months after treatments. Near vision is displayed on the x axis, distance vision is displayed on the y axis, and the percentage of patients with each combination of distance and near vision is plotted.

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  Figure 5. Comparison of postoperative depth of focus (A) and spherical aberration (B).

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  Figure 6. Survey for quality of vision and satisfaction in patients after the treatment.

Reference

References

1. Heatley CJ, Spalton DJ, Boyce JF, Marshall J. A mathematical model of factors that influence the performance of accommodative intraocular lenses. Ophthalmic Physiol Opt. 2004; 24:111–8.

2. Hersh PS. Optics of conductive keratoplasty: implications for presbyopia management. Trans Am Ophthalmol Soc. 2005; 103:412–56.

3. Haw WW, Manche EE. Conductive keratoplasty and laser thermal keratoplasty. Int Ophthalmol Clin. 2002; 42:99–106.

4. Wright KW, Guemes A, Kapadia MS, Wilson SE. Binocular function and patient satisfaction after monovision induced by myopic photorefractive keratectomy. J Cataract Refract Surg. 1999; 25:177–82.

5. Vinciguerra P, Nizzola GM, Nizzola F, et al. Zonal photorefractive keratectomy for presbyopia. J Refract Surg. 1998; 14:S218–21.

6. Bauerberg JM. Centered vs. inferior off-center ablation to correct hyperopia and presbyopia. J Refract Surg. 1999; 15:66–9.

7. Williams DK. One-year results of laser vision correction for low to moderate hyperopia. Ophthalmology. 2000; 107:72–5.

8. Goldberg DB. Laser in situ keratomileusis monovision. J Cataract Refract Surg. 2001; 27:1449–55.

9. Miranda D, Krueger RR. Monovision laser in situ keratomileusis for pre-presbyopic and presbyopic patients. J Refract Surg. 2004; 20:325–8.

10. Alió JL, Chaubard JJ, Caliz A, et al. Correction of presbyopia by technovision central multifocal LASIK (presbyLASIK). J Refract Surg. 2006; 22:453–60.

11. Reinstein DZ, Couch DG, Archer TJ. LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform. J Refract Surg. 2009; 25:37–58.

12. Reinstein DZ, Archer TJ, Gobbe M. LASIK for Myopic Astigmatism and Presbyopia Using Non-Linear Aspheric Micro-Monovision with the Carl Zeiss Meditec MEL 80 Platform. J Refract Surg. 2011; 27:23–37.

13. Fukuyama M, Oshika T, Amano S, Yoshitomi F. Relationship between apparent accomodation and corneal multifocality in pseudophakic eyes. Ophthalmology. 1999; 106:1178–81.

14. Oshika T, Mimura T, Tanaka S, et al. Apparent accommodation and corneal wavefront aberration in pseudophakic eyes. Invest Ophthalmol Vis Sci. 2002; 43:2882–6.

15. Michaels DD. Visual Optics and Refraction: A Clinical Approach. 1st ed.St Louis: Mosby;1975. p. 273–4.

16. Kurtz D. Presbyopia. Brookman KE, editor. Refractive Management of Ametropia. Boston: Butterworth-Heinemann;1996. p. 145–79.

17. Adler F. Physiology of the Eye: Clinical Application. 8th ed.St Louis: Mosby;1987. p. 200–1.

18. Goldberg DB. Comparison of myopes and hyperopes after laser in situ keratomileusis monovision. J Cataract Refract Surg. 2003; 29:1695–701.

19. Yasuda A, Yamaguchi T. Steepening of corneal curvature with contraction of the ciliary muscle. J Cataract Refract Surg. 2005; 31:1177–81.

20. Glasser A, Troilo D, Howland HC. The mechanism of corneal accommodation in chicks. Vision Res. 1994; 34:1549–66.

21. Artola A, Patel S, Schimchak P, et al. Evidence for delayed presbyopic after photorefractive keratectomy for myopia. Ophthalmology. 2006; 113:735–41.e1.

22. Marcos S, Moreno E, Navarro R. The depth-of-field of the human eye from objective and subjective measurements. Vision Res. 1999; 39:2039–49.

23. Nio YK, Jansonius NM, Wijdh RH, et al. Effect of methods of myopia correction on visual acuity, contrast sensitivity, and depth of focus. J Cataract Refract Surg. 2003; 29:2082–95.

24. Ninomiya S, Fujikado T, Kuroda T, et al. Changes of ocular aberration with accommodation. Am J Ophthalmol. 2002; 134:924–6.

25. Chun YS, Lee HI, Dausch D, Kim JC. Long-term results of presbyopic corneal surface ablation with eximer laser. J Korean Ophthalmol Soc. 2008; 49:1061–70.

26. Jain S, Ou R, Azar DT. Monovision outcomes in presbyopic in-dividuals after refractive surgery. Ophthalmology. 2001; 108:1430–3.

27. Ang RE, Chan WK, Wee TL, et al. Efficacy of an aspheric treatment algorithm in decreasing induced spherical aberration after laser in situ keratomileusis. J Cataract Refract Surg. 2009; 35:1348–57.

28. Holladay JT, Van Dijk H, Lang A, et al. Optical performance of multifocal intraocular lenses. J Cataract Refract Surg. 1990; 16:413–22.

29. Oshika T, Klyce SD, Applegate RA, et al. Comparison of corneal wavefront aberrations after photorefractive keratectomy and laser in situ keratomileusis. Am J Ophthalmol. 1999; 127:1–7.

30. Marcos S, Barbero S, Llorente L, Merayo-Lloves J. Optical response to LASIK surgery for myopia from total and corneal aberration measurements. Invest Ophthalmol Vis Sci. 2001; 42:3349–56.

31. Duane A. Normal values of the accommodation at all ages. JAMA. 1912; 52:1010–3.

32. Heatley CJ, Spalton DJ, Hancox J, et al. Fellow eye comparison between the 1CU accommodative intraocular lens and the Acrysof MA30 monofocal intraocular lens. Am J Ophthalmol. 2005; 140:207–13.

33. Hancox J, Spalton D, Heatley C, et al. Objective measurement of intraocular lens movement and dioptric change with a focus shift accommodating intraocular lens. J Cataract Refract Surg. 2006; 32:1098–103.

34. Chiam PJ, Chan JH, Haider SI, et al. Functional vision with bi-lateral ReZoom and ReSTOR intraocular lenses 6 months after cataract surgery. J Cataract Refract Surg. 2007; 33:2057–61.

35. Schmidinger G, Simader C, Dejaco-Ruhswurm I, et al. Contrast sensitivity function in eyes with diffractive bifocal intraocular lenses. J Cataract Refract Surg. 2005; 31:2076–83.

36. Kohnen T, Allen D, Boureau C, et al. European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. Ophthalmology. 2006; 113:584.e1.

37. Vingolo EM, Grenga P, Iacobelli L, Grenga R. Visual acuity and contrast sensitivity: AcrySof ReSTOR apodized diffractive versus AcrySof SA60AT monofocal intraocular lenses. J Cataract Refract Surg. 2007; 33:1244–7.

38. Wachler BS, Krueger RR. Normalized contrast sensitivity values. J Refract Surg. 1998; 14:463–6.

39. Reinstein DZ, Archer TJ, Couch D, et al. A new night vision disturbances parameter and contrast sensitivity as indicators of success in wavefront-guided enhancement. J Refract Surg. 2005; 21:S535–40.