Central PresbyLASIK option for selected patients

October 15, 2005

Presbyopic LASIK using a multifocal ablation profile where the central zone is steepened for near and the peripheral zone targeted for distance (central PresbyLASIK) appears to be able to enhance near vision while maintaining good distance vision to offer spectacle independence to many patients and without loss of contrast sensitivity, said W. Bruce Jackson, MD, at the refractive surgery subspecialty day meeting sponsored by the International Society of Refractive Surgery of the American Academy of Ophthalmology.

Chicago-Presbyopic LASIK using a multifocal ablation profile where the central zone is steepened for near and the peripheral zone targeted for distance (central PresbyLASIK) appears to be able to enhance near vision while maintaining good distance vision to offer spectacle independence to many patients and without loss of contrast sensitivity, said W. Bruce Jackson, MD, at the refractive surgery subspecialty day meeting sponsored by the International Society of Refractive Surgery of the American Academy of Ophthalmology.

“Hyperopes seem to do better with this approach than myopes and so far we have little data on its use in emmetropic eyes,” said Dr. Jackson, professor and chairman of ophthalmology, University of Ottawa, Ontario, Canada. “For now, however, it seems to offer a good alternative for young presbyopes with low refractive errors who do not want intraocular surgery as well as for patients who have residual refractive errors after IOL implantation 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,” Dr. Jackson said.

His comments were based on results from a multicenter Canadian study of 33 hyperopes (mean age 56 years, mean SE +1.87 D) who underwent bilateral customized hyperopic treatment (CustomVue, VISX) combined with a presbyopic central treatment. The procedures were performed using the S4 excimer laser (AMO/VISX) and Amadeus microkeratome (AMO). 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, while the proportion able to see 20/20 was around 70% to 78% early in follow-up and was increasing at 12 months. All patients were also able to read J3, although 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 to almost preoperative levels by 12 months.

Results of a questionnaire showed patients were quite satisfied with their overall vision and their day and night vision. 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.