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K.-M. A. Tuan, B. Jackson, G. Mintsioulis, D. Chernyak; Characteristics of Successful Aspheric Hyperopic Lasik Correction. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2444.
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To determine the factors necessary for patient satisfaction when using an aspheric ablation profile for near-vision enhancement of hyperopic presbyopia.
This study was a retrospective analysis of a single-center, nonrandomized clinical trial. The site was one of four centers conducting clinical trials for this treatment. We used one site for this analysis to remove site variability. 66 eyes of 33 hyperopic patients underwent customized refractive surgery Surgeries were performed using the VISX STAR S4 or VISX STAR S4 IR excimer laser system (AMO, Santa Clara, CA).
60 eyes completed 6 months of follow-up visits. 50 eyes completed 12 months of follow-up visits. 75% of the eyes improved by 2 or more lines. At 6 months, 93% of subjects had binocular simultaneous uncorrected vision ≥ 20/25 distance and J3 near. At 12 months, 100% of subjects had achieved binocular simultaneous uncorrected vision ≥ 20/25 and J3, and 72% of subjects had vision ≥ 20/25 and J1. Patients with higher pre-op refractive error or worse pre-op DCNVA were more likely to report satisfaction after receiving the aspheric ablation (ordinal logistic regression, both p<0.05). Postop, higher spherical aberration (SA) and lower coma or trefoil were associated with greater satisfaction with intermediate and near vision (ordinal logistic regression, all p<0.05). Subjects whose procedures included iris registration (IR) experienced better outcomes, including a significantly (p<0.05) stronger asphericity effect, better near vision, and greater satisfaction under night glare conditions at most time points, than subjects who did not have IR.
Aspheric ablations to expand near functional vision were stable over 12 months. The customized hyperopic treatment with negative SA and IR provided better outcomes. The patients’ pre-op prescriptions and near vision were critical factors in visual outcome and satisfaction. Patients with clinically significant hyperopia and significant reduction of distance-corrected near vision were more likely to have near vision improvement and to be satisfied with results.
www.clinicaltrials.gov to be registered on 12/31/2007
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