Multifocal ablations for presbyopia explored

March 15, 2007

Las Vegas-Customized multifocal ablations, used to correct both hyperopia and presbyopia, appear to offer good results for both uncorrected distance and near vision and may provide another option for surgeons and their patients, said Marguerite B. McDonald, MD, FACS, at the American Academy of Ophthalmology annual meeting.

She presented 1-year outcomes from the Canadian trial lead by W. Bruce Jackson, MD, professor and chairman of ophthalmology, University of Ottawa, Ontario, Canada, of 43 hyperopic presbyopic patients (75 eyes) treated with customized bilateral ablations. In addition, the 6-month U.S. clinical trial results of 20 patients (20 eyes), treating the dominant eye for distance and the non-dominant eye with a multifocal ablation, were also encouraging. Colman R. Kraff, MD, director of refractive surgery, Kraff Eye Institute, Chicago, led the U.S. study.

In each study, an excimer laser (VISX S4, Advanced Medical Optics [AMO]) was used to create the multifocal ablation pattern using the pupil centroid shift compensation and iris registration upgrades. The central zone is steepened for near, and the peripheral area is targeted for distance. The treatments were customized both to patients' pupil sizes and to their individual wavefronts.

The Canadian results were very encouraging, with 82% of the eyes (n = 71) achieving a binocular uncorrected near vision of J1 or better and 100% achieving J3 or better at 1 month after refractive surgery. The monocular uncorrected near vision was also measured. At 1 month postop, 68% of the eyes (n = 71) achieved J1 or better vision and 92% were J3 or better, Dr. McDonald noted.

Manifest refraction was followed for 1 year postoperatively. Preoperative manifest refraction spherical equivalent (MRSE) was +1.91 ± 0.59 D and dropped to –0.19 ± 0.71 D at 1 month postop. At 1 year after surgery, the MRSE measured +0.12 ± 0.38 D.

"The majority of patients were satisfied with their overall visual sharpness and clarity without [spectacle] correction at 6 and 12 months after surgery," said Dr. McDonald, who is also a clinical professor of ophthalmology, Tulane University Health Sciences Center, New Orleans.