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C. Suto, F. W. Medeiros, S. E. Wilson; Patient Satisfaction With Monovision in Laser in situ Keratomileusis. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1000.
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To investigate the outcomes of laser in situ keratomileusis (LASIK) for presbyopic patients and determine factors that predict dissatisfaction with monovision (MV) refractive surgery.
In this retrospective study, 348 patients (674 eyes) that had LASIK between October 2003 and March 2006 with a follow-up of at least 3 months were examined. All patients older than 40 years were divided into three groups: Group A included ages 40 to 45 years; Group B included ages 46 to 53 years; Group C included ages 54 years and older. The following factors were evaluated: age at the time of initial surgery, gender, preoperative spherical equivalent (SE), target for MV correction, type of MV, postoperative SE, level of anisometropia, uncorrected visual acuity (UCVA) with both eyes, predictability of outcome, enhancement frequency, adjustment period, and patient satisfaction.
Our database included 101 patients (180 eyes) older than 40 years who chose MV, 95 patients (190 eyes) older than 40 years who chose full distance correction, and the remaining 152 patients (304 eyes) who were 21 to 39 years of age. In MV patients, Group C, as expected, required the highest level of residual myopia in the MV eye (p<0.001, A vs B p=0.044; A vs C p=0.004), and, therefore, had the greatest level of anisometropia (p<0.001, A vs B p=0.039; A vs C p=0.001). In MV patients, we observed differences among the three groups in the rate of enhancement: Group A (7.8%), Group B (22.7%), and Group C (12.0%) (p<0.05). Satisfaction after the first surgery was also lower in Group B (55.2%), when compared to Group A (82.4%) and Group C (75.9%) (p<0.05). Dissatisfaction increased with anisometropia of -1.5D or more. MV patients commonly sought enhancement for the distance eye when UCVA was 20/30 or less.
This study demonstrates that LASIK for MV is successful in the majority of patients, but that satisfaction differs with the age of the patient. Retreatment is common when the vision in the distance eye is 20/30 or less.EY10056, EY15638, and Research to Prevent Blindness, New York, NY.
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