Findings from a retrospective study assessing vision and well-being among patients with presbyopic hyperopia who underwent bilateral wavefront-guided LASIK or refractive lens exchange with bilateral multifocal IOL implantation show similarly high satisfaction for both groups.
The analysis was performed using a stratified random sample identified from the Optical Express database and included 438 patients in each group. None of the patients in the LASIK group was treated for monovision, and comparison of baseline refractive and demographic characteristics showed the two groups were well matched.
Dr. Schallhorn summarized the findings from responses to an online questionnaire asking patients about quality of life and quality of vision issues, symptoms, and satisfaction at 1 month after surgery. Overall, the results showed the LASIK patients reported better quality of vision and better quality of life, while the IOL patients indicated less dry eye symptoms and better near vision.
"These findings are from a large retrospective analysis," said Dr. Schallhorn, in private practice, San Diego, and medical director, Optical Express. "However, the questionnaire was given in the early postoperative time period and we know that healing and adaptation after hyperopic treatments can take many more months. Therefore we plan [to conduct] further, more carefully controlled studies to analyze outcomes 1 year after surgery."
Bilateral wavefront-guided LASIK was performed using a 6.0/9.0 mm ablation zone. There was a 1-week waiting period between fellow-eye IOL surgeries. IOL patients completed the online survey 1 month after the second eye surgery.
On average, the patients in the study had a mean spherical error of about +2.5 D and were approaching 60 years of age. The gender distribution was significantly different between groups with males and females equally represented in the LASIK cohort while women represented the majority of IOL patients (59%). There was also a statistically significant difference in mean patient age, which was 59.5 years in the IOL group and 58.3 years for the LASIK patients. However, the approximate 1-year gap was not deemed clinically relevant, Dr. Schallhorn said.
Data favoring LASIK over IOL surgery were seen in responses to questions about glare and halos at night, night driving, normal activities, and physical activities. The IOL group reported better outcomes in terms of reading vision and less dry eye symptoms, although the between-group difference in dry eye complaints was less dramatic than anticipated, Dr. Schallhorn said.
Using a 5-point scale, patients were asked to rate severity of glare at 1 month as absent to severe. Glare was reported as none or little by 92% of patients who had LASIK and 73% of those in the IOL group.
The question about night driving also used a 5-point response scale for patients to rate how their ability had changed after surgery. Here, the results were more clearly in favor of LASIK. Whereas 68% of LASIK patients considered their night driving ability improved, only 37% of IOL recipients reported improvement.