Long-term Outcomes After LASIK Using a Hybrid Bi-aspheric Micro-monovision Ablation Profile for Presbyopia Correction

Abstract

PURPOSE: To evaluate visual outcomes 6 years after hybrid bi-aspheric multifocal central laser in situ keratomileusis for presbyopia correction (PresbyLASIK) treatments. METHODS: Thirty-eight eyes of 19 patients consecutively treated with central PresbyLASIK were assessed. The mean age of the patients was 51 ± 3 years at the time of treatment with a mean spherical equivalent refraction of −0.57 ± 1.98 diopters (D) and mean astigmatism of 0.58 ± 0.57 D. Monocular corrected distance visual acuity (CDVA), corrected near visual acuity (CNVA), and distance-corrected near visual acuity (DCNVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), and uncorrected near visual acuity (UNVA) were assessed preoperatively and postoperatively for the dominant eye, non-dominant eye, and binocularly. Subjective quality of vision and near vision were assessed using the 10-item, Rasch-scaled, Quality of Vision (QoV) Questionnaire and Near Activity Visual Questionnaire (NAVQ), respectively. RESULTS: At 6 years postoperatively, mean binocular UDVA was 20/18 ± 4 and mean binocular UNVA and UIVA were 0.11 ± 0.13 and −0.08 ± 0.08 logRAD, respectively. Spherical equivalent showed a slow hyperopic drift of +0.10 D per year with refractive astigmatism stable from 6 weeks postoperatively. Defocus curves showed an improvement of 0.4 Snellen lines at best focus from 1 to 6 years of follow-up, reaching preoperative levels. Compared to the preoperative status, the corneal and ocular spherical aberrations (at a 6-mm diameter) decreased and were stable from 3 months of follow-up. Questionnaires revealed a postoperative unaided QoV score comparable to preoperative scores and with an improved postoperative unaided NAVQ score compared to preoperative scores with best correction. CONCLUSIONS: Presbyopic treatment using a hybrid bi-aspheric micro-monovision ablation profile is safe and efficacious even after 6 years postoperatively. The postoperative outcomes indicate improvements in binocular vision at far, intermediate, and near distances. An 8% re-treatment rate should be considered to increase satisfaction levels, including a 3% reversal rate.