Correction of presbyopia by central biaspheric multifocal LASIK

(PRESBYMAX®) in myopic patients.

Jorge L. Alió MD, PhD,Dolores Ortiz PhD,

Esperanza Sala, MScAna B. Plaza, MSc

VISSUMInstituto Oftalmológico de Alicante

Universidad Miguel HernándezAlicante (Spain)

Financial disclosure– AcuFocus, Inc. - D– Akkolens - D,A– Alcon Laboratories, Inc. - D– Bausch & Lomb Surgical - D,A– Carl Zeiss Meditec - D– Chemedica - D– Eyemaginations - A– Index Instruments -P– IntraLase Corporation - D

Category Code Specific Financial Interest

Product P I earn royalty or derive other financial gain from an ophthalmic product or service.

Investor R I have a significant investment interest in a company that makes/develops/provides ophthalmic products or services.

Consultant AI receive a retainer, ad hoc fees, or other consulting income from a company that makes/develops/provides ophthalmic products or services.

B I am a member of the speaker's bureau of a company that makes/develops/provides ophthalmic products or services.

C I provide practice management or marketing consulting services to ophthalmic practices.

Research D My research is fully or partially funded by a company that makes/develops/provides ophthalmic products or services.

Travel EMy travel expenses have been reimbursed, paid in full or subsidized, by a company that makes/develops/provides ophthalmic products or services.

Employee y I am a full-time employee of a company that makes/develops/provides ophthalmic products or services

Z I am a part-time employee of a company that makes/develops/provides ophthalmic products or services

Spouse SMy spouse has a financial relationship with a company that makes/develops/produces ophthalmic products or services, encompassing either royalties, investment, consulting/speakers bureau, research grants, travel reimbursement or employment.

Purpose

• To study refractive and visual outcomes of central presbylasik technique (PresbyMax®),

based on the creation of a central area for near vision (+2 D of addition), in myopic patients.

Patients

• Study design: Prospective, non comparative pilot study that included a total of 42 myopic eyes with age between 40 and 56 years.

• Inclusion criteria: myopia –4 (D), astigmatism –2 (D), corneal curvature between 40 and 48 D, pachymetry >500, and near vision of J3 with addition of +1.50 D.

Methods

• The ablation pattern was performed using the Esiris excimer laser (Schwind, Frankfurt,Germany), centred in corneal vertex and biaspheric profile.

• The main outcome measures were refraction, uncorrected and best corrected visual acuities for near and distance, corneal aberrations (spherical and coma) and patient satisfaction.

Results: spherical equivalent

At 6 months after surgery, the spherical equivalent refraction was –0.21±0.37 (D).

SE

-6

-5

-4

-3

-2

-1

0

1

PREOP 1 MONTH 3 MONTH 6 MONTHS

Time (months)

SE

(D

)

Visual acuityThe distance decimal visual acuity with without correction 0.88±0.14.

DUCVA

0

0,2

0,4

0,6

0,8

1

1,2

PREOP 24 H. 1 MONTH 3 MONTH 6 months

Time (months)

VA

(d

ec

ima

l)

Visual acuity

Mean near decimal visual acuity without correction 0.93±0.25.

Mean near distance corrected decimal visual acuity was 0.53±0.26.

NUCVA

00,30,6

0,91,21,5

PREOP 24 H. 1 MONTH 3 MONTH 6 months

Time (months)

VA

(d

ec

ima

l)

DCNVA

0

0,2

0,40,6

0,8

1

PREOP 1 MONTH 3 MONTH 6 MONTHS

Time (months)

VA

(d

ec

ima

l)

ADD

00,5

11,5

2

PREOP 1 MONTH 3 MONTH 6 month

Time (months)

AD

D (

D)

Addition

The addition change from 1.3 preop to 0.88D after 6 months postoperative.

Results: Corneal aberrations• Spherical corneal aberrations showed a trend towards

positive increase while coma corneal aberration did not change.

Spherical Aberration

0

0,2

0,4

0,6

0,8

1

preop 1 month 3 months 6 months

Time (months)

RM

S (

mic

ron

s)

Coma Aberration

0

0,2

0,4

0,6

0,8

1

preop 1 month 3 months 6 months

Time (months)

RM

S (

mic

ron

s)

Conclusions

• Central presbylasik with biaspherical profile may be used to improve functional near vision in patients with presbyopia associated with low to moderate myopia.

• 70% of patients could dispense with the use of glasses both for far and near 6 months after the surgery.