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Asphericity Asphericity and Q Adjustments in and Q Adjustments in Treating Treating Presbyopia Presbyopia Mounir Khalifa Mounir Khalifa Prof. of Ophthalmology, Tanta University Prof. of Ophthalmology, Tanta University Horus Vision Correction Center Horus Vision Correction Center Alexandria, Egypt Alexandria, Egypt

Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

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Page 1: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

AsphericityAsphericity and Q Adjustments in and Q Adjustments in Treating Treating PresbyopiaPresbyopia

Mounir KhalifaMounir KhalifaProf. of Ophthalmology, Tanta UniversityProf. of Ophthalmology, Tanta University

Horus Vision Correction CenterHorus Vision Correction CenterAlexandria, EgyptAlexandria, Egypt

Page 2: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

The Mechanism of Accommodation

Page 3: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

The Optics of Accommodation

The loss of accommodation leads to presbyopia

Page 4: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Presbyopia

Duane measured Duane measured the amplitude of the amplitude of accommodation in accommodation in 1500 subjects using 1500 subjects using the subjective the subjective ““push uppush up””technique (Duane, technique (Duane, 1912).1912).

Depth of Focus

Page 5: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Looking closer to Presbyopia

NearNear reflexreflex(Nervus (Nervus occulomotoriusocculomotorius))

3.3. MiosisMiosis withwith ageage

2.2. ConvergenceConvergence withwith ageage

1.1. AccommodationAccommodation withwith ageage

withwith accommodationaccommodation

Page 6: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

0

5

10

15

20

25

30

35

40

45

-0,9

-0,8

-0,7

-0,6

-0,5

-0,4

-0,3

-0,2

-0,1 0 0,1 0,2 0,3 0,4 0,5

Q-Value

Num

ber

of E

yes (

n=17

6)

The mean shape of the human cornea P.M. Kiely, G. Smith and L.G. CarneyOptica Acta, 1982, Vol.29, No. 8, 1027-1040

Most Corneas are Negatively Aspheric (Prolate)

Population Distribution of Q-Values

Prolate OblateProlate Oblate

Q = 0Q = 0 (Spherical)(Spherical)

Corneal AsphericityCorneal Asphericity

Minimizes Spherical Aberration

Page 7: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyper-Prolate Enhances Depth of Focus (DoF)

IROC, Curtesy Prof. Dr. M. Mrochen

DoFDoF Increases with Negative QIncreases with Negative Q

Page 8: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

The depth of focus curve (blue curve) strongly increased (up to The depth of focus curve (blue curve) strongly increased (up to 2D), but 2D), but therethere are a maximum before a decrease for strong values (0.9are a maximum before a decrease for strong values (0.9µµm).m).

Mean Spherical Aberration vs. Depth of Focusm

agni

tude

-D

OF

magnitude spherical aberration (SA)

negative SAnegative SA positive SApositive SA

DoF Increases with Negative SADoF Increases with Negative SA

Page 9: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

The combination of mono-vision (central rays are focused in front of the retina) and a hyper-prolate shape of the cornea (peripheral rays are focused behind the central rays) creates a larger depth of field.

≈ -1.50D

Advanced Mini Mono-Vision HyperHyper--Prolate Aspheric CorneaProlate Aspheric Cornea

Page 10: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

When the eye focuses on the near field (accommodation) the pupil constricts (miosis).

Miosis caused by Nervus occulomotorius HyperHyper--Prolate for Near EyeProlate for Near Eye

Page 11: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Taking benefit of the miosis for advanced monovision procedure, by excluding the peripheral rays of light, only the central rays are now focused on the retina. Miosis will limit the depth of field to close.

Miosis supporting accommodationHyperHyper--Prolate for Near EyeProlate for Near Eye

Page 12: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Inducing SA on Presbyopic Subjects with AOCourtesy Prof. Dr. Ronald Krueger

Using Imagine Eyes Mirror at U of Rochester

Large StrokeDeformableMirror

WavefrontSensor

VisualAcuity

PhoroptorSLD

Eye

ContrastSensitivity

Page 13: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

NearBeyond ∞ Distance

SA Increases Depth of Focus

beyond infinity Defocus (D) near

Through Focus Retinal Image Quality

-2 -1.5 -1 -0.5 0 0.5 1 1.5 2No Spherical Aberration

0.5 D

Courtesy Prof. Dr. Ronald Krueger

Page 14: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

SA Increases Depth of Focus

NearBeyond ∞ Distance

Through Focus Retinal Image Quality

beyond infinity Defocus (D) near

-2 -1.5 -1 -0.5 0 0.5 1 1.5 2

+SA

No aberration

Positive Spherical Aberration

~2 D

Courtesy Prof. Dr. Ronald Krueger

Page 15: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

SA Increases Depth of Focus

NearBeyond ∞ Distance

Through Focus Retinal Image Quality

beyond infinity Defocus (D) near

-2 -1.5 -1 -0.5 0 0.5 1 1.5 2

-SA

+SA

No aberration

Negative Spherical Aberration

~2 D

Courtesy Prof. Dr. Ronald Krueger

Page 16: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

1 2 3 4 5 6 7refractive difference / dpt

difference in size of the retinal image

2%

4%

6%

8%

100%100%

50%50%

0%0%

fusionfusion

Courtesy of T. Seiler

Page 17: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

The global optimum shape of the cornea is not a The global optimum shape of the cornea is not a multifocal cornea but an aspheric corneamultifocal cornea but an aspheric cornea

It does not produce 2 foci and the brain selects the It does not produce 2 foci and the brain selects the appropriate image like in bifocal appropriate image like in bifocal IOLsIOLs

The driving force is the pupil diameter that shifts The driving force is the pupil diameter that shifts the focus of the opticsthe focus of the optics

PresbyLASIK and Asphericity

The global optimum has the advantages that The global optimum has the advantages that additional reading glasses can help and that the additional reading glasses can help and that the profile is forgiving regarding profile is forgiving regarding decentrationdecentration

Page 18: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

DecentrationDecentration0.0 mm 0.3 mm 0.5 mm0.0 mm 0.3 mm 0.5 mm

Distant vision with CSIDistant vision with CSI

Disadvantage of CSI

Page 19: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Mounir KhalifaMounir KhalifaProf. of Ophthalmology, Tanta UniversityProf. of Ophthalmology, Tanta University

Horus Vision Correction CenterHorus Vision Correction CenterAlexandria, EgyptAlexandria, Egypt

Your Name

Evaluation of Aspheric Ablation Profile and Evaluation of Aspheric Ablation Profile and CustomCustom--Q Adjustments in Treating PresbyopiaQ Adjustments in Treating Presbyopia

Page 20: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

OBJECTIVEOBJECTIVE

Evaluation of modifying the corneal Evaluation of modifying the corneal asphericityasphericity and and monovisionmonovision correction in myopia and correction in myopia and hyperopiahyperopia with with the aspheric ablation profile and customthe aspheric ablation profile and custom--Q Q adjustments in correction of adjustments in correction of presbyopiapresbyopia..

Page 21: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Mechanism of action

• Increasing prolatness ( negative Q -value )increasing –ve spherical

aberration increasing depth of focus.

• Modified monovision ( < -1.5 D ).

Page 22: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Mechanism of action

• Applying myopic ablation with certain amount ( e.g. -1.5 D), then applying hyperopic ablation with the same amount ( +1.5 D) will create negative Q-value according to the certain amount used.

• That is why shifting Q-value to negative side overcorrects myopia and undercorrects hyperopia, and the reverse in the resulted Q-value; it undertargets in myopia and overtargets in hyperopia.

Page 23: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Material & MethodsMaterial & Methods

Hyperopia (n=32)Hyperopia (n=32)Group AGroup A

Myopia (n=24)Myopia (n=24)Group BGroup B

Mean ageMean age 46. 3746. 37 49.6749.67

Mean MRSEMean MRSE +2.67D +2.67D ±±1.87 D1.87 D --3.87 D 3.87 D ±±2.57 D2.57 D

Mean cylinderMean cylinder --1.37D D 1.37D D ±±1.167D1.167D --1.87 D 1.87 D ±± --1.37 D1.37 D

Mean add for nearMean add for near +1.67 D+1.67 D±±0.62 D0.62 D +1.75D +1.75D ±± 0.75D0.75D

Page 24: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Material & MethodsMaterial & Methods

•• All cases had LASIK with All cases had LASIK with MoriaMoria microkeratommicrokeratom M2 M2 and Allegretto Eyeand Allegretto Eye--Q FQ F--CAT profile with QCAT profile with Q--adjustment (Wave Light).adjustment (Wave Light).

•• NonNon--dominant eye (NDE) was targeted with more dominant eye (NDE) was targeted with more negative Q value and myopic defocus in relation to negative Q value and myopic defocus in relation to dominant eye (DE).dominant eye (DE).

• We followed :Defocus Diff. -1.25 D. in NDEQ-value Diff. -0.2 in NDE

Page 25: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Material & MethodsMaterial & Methods

Preoperative and postoperative UCDVA, BCDVA, DCNVA, Preoperative and postoperative UCDVA, BCDVA, DCNVA, UCNVA, and BCNVA were evaluated, monocular and binocular, UCNVA, and BCNVA were evaluated, monocular and binocular, mesopicmesopic contrast sensitivity ( CSV 1000), and contrast sensitivity ( CSV 1000), and HOAHOA’’ss..

•• Patient satisfaction (visual functionPatient satisfaction (visual function--14) regarding glasses 14) regarding glasses independence was evaluated. independence was evaluated.

•• Follow up to 3 months was recorded.Follow up to 3 months was recorded.

Page 26: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Results of VAResults of VA

HyperopeHyperopePreopPreopDE NDEDE NDE

HyperopeHyperopePostopPostopDE NDEDE NDE

MyopeMyopePreopPreopDE NDEDE NDE

MyopeMyopePostopPostopDE NDEDE NDE

UCDVAUCDVAUCDVA AOUCDVA AO

0.5 0.30.5 0.30.60.6

0.9 0.50.9 0.50.90.9

0.4 0.30.4 0.30.50.5

0.9 0.60.9 0.60.90.9

BCDVABCDVABCDVA AOBCDVA AO

0.9 0.70.9 0.70.90.9

0.9 0.80.9 0.80.90.9

1.0 0.91.0 0.91.01.0

0.9 0.70.9 0.70.90.9

DCNVADCNVADCNVA AODCNVA AO

0.6 0.50.6 0.50.60.6

0.8 0.70.8 0.70.80.8

0.6 0.50.6 0.50.70.7

0.5 0.40.5 0.40.60.6

UCNVAUCNVAUCNVA AOUCNVA AO

0.4 0.30.4 0.30.40.4

0.8 0.90.8 0.91.01.0

0.8 0.80.8 0.80.90.9

0.7 0.80.7 0.80.80.8

BCNVABCNVABCNVA AOBCNVA AO

0.8 0.70.8 0.70.80.8

0.8 0.90.8 0.91.01.0

1.0 0.91.0 0.91.01.0

0.9 0.80.9 0.80.90.9

In myopes, 3(6%) eyes lost 2 lines and 8 (16%) eyes lost 1 line of BCDVA. No loss of lines in hyperopic eyes.

Page 27: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

ResultsResults

HyperopeHyperopePreopPreopDE NDEDE NDE

HyperopeHyperopePostopPostopDE NDEDE NDE

MyopeMyopePreopPreopDE NDEDE NDE

MyopeMyopePostopPostopDE NDEDE NDE

Mean of Mean of MRSEMRSE

+2.2 +3.12+2.2 +3.12 +0.24 +0.24 --1.121.12 --3.37 3.37 --4.54.5 --.68 .68 --1.411.41

Mean of Q Mean of Q 0.02 0.040.02 0.04 --0.9 0.9 --1.21.2Overtarget**Overtarget**

--0.1 0.1 --0.060.06 --0.54 0.54 --0.620.62Undertarget*Undertarget*

Mean of Mean of HOAHOA

0.53 0.53 0.480.48 0.320.32 0.350.35

Mean of Mean of Sph. AbSph. Ab

0.430.43 --0.060.06 0.260.26 --0.180.18

No significant change

Significant shift to negative side

*Undertarget mean 0.31

** Overtarget mean -0.19

Page 28: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

ResultsResults

•• Patient satisfaction for binocular farPatient satisfaction for binocular far--and near and near different visual activities (using Visual Function VFdifferent visual activities (using Visual Function VF--14) was 86% in 14) was 86% in myopesmyopes and 100% in and 100% in hyperopeshyperopes. .

Page 29: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction
Page 30: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

MesopicMesopic Contrast SensitivityContrast Sensitivity

Group AGroup A

0.5

1.0

1.5

2.0

2.5

3 6 12 18

Cycles Per Degree

LogM

AR

PreopPostop

Dim light with Glare

Bright light no Glare

Group BGroup B

0.5

1.0

1.5

2.0

2.5

12 18

Cycles Per Degree

LogM

AR

PreopPostop

Dim light with Glare

Bright light no Glare

Hyperopic- Group A

Myopic- Group B

*

Page 31: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Treatment plan inTreatment plan inhypermetropichypermetropic casescases

•• ASSIS ASSIS nomogramnomogram: Add +0.16 spherical adjustment : Add +0.16 spherical adjustment for each 0.1 change in Q value.for each 0.1 change in Q value.

•• Target QTarget Q: DE : DE --0.80.8NDE NDE --1.01.0

•• Target MRSETarget MRSE: DE : DE planoplanoNDE NDE --1.251.25

Page 32: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

HypermetropicHypermetropic casecase

•• Female 46 yearsFemale 46 years•• PreopPreop: : OD +4.0 OD +4.0 --0.25 NDE0.25 NDE

UCDVA 0.3 BCDVA 0.7UCDVA 0.3 BCDVA 0.7OS +3.0 OS +3.0 --0.75 DE0.75 DEUCDVA 0.4 BCDVA 0.8UCDVA 0.4 BCDVA 0.8

•• PostopPostop: : OD OD --1.25 1.25 UCDVA 0.5 BCDVA 0.7UCDVA 0.5 BCDVA 0.7OS +0.25OS +0.25UCDVA 0.9 BCDVA 0.9UCDVA 0.9 BCDVA 0.9

OA UCDVA 0.9 UCNVA 0.9OA UCDVA 0.9 UCNVA 0.9

Page 33: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

HypermetropicHypermetropic casecase-- DEDE

Page 34: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case-DE

Page 35: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case-DE

Page 36: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

HypermetropicHypermetropic casecase-- NDENDE

Page 37: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case-NDE

Page 38: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case-NDE

Page 39: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Treatment plan inTreatment plan inmyopic casesmyopic cases

•• ASSIS ASSIS nomogramnomogram: Spherical adjustment factor per 0.1 change in Q: Spherical adjustment factor per 0.1 change in Q--value:value:

<<--2.0 +0.202.0 +0.20--2.0 +0.202.0 +0.20--3.0 +0.273.0 +0.27--4.0 +0.254.0 +0.25

•• Target QTarget Q--valuevalue: DE : DE --0.80.8NDE NDE --1.01.0

•• Target MRSETarget MRSE: DE : DE planoplanoNDE NDE --1.251.25

Page 40: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Myopic caseMyopic case

•• Female 44 years Female 44 years •• PreopPreop: : OD OD --1.75 1.75 --2.0X25 DE2.0X25 DE

UCDVA 0.4 BCDVA 0.9UCDVA 0.4 BCDVA 0.9

OS OS --2.5 2.5 --1.25 X 180 NDE1.25 X 180 NDEUCDVA 0.3 BCDVA 0.8UCDVA 0.3 BCDVA 0.8

•• PostopPostop: : OD +0.75 OD +0.75 --0.5X45 0.5X45 UCDVA 0.8 / BCDVA 0.9UCDVA 0.8 / BCDVA 0.9

OS OS --0.250.25UCDVA 0.9 BCDVA 0.9UCDVA 0.9 BCDVA 0.9

OA UCDVA 0.9 UCNVA 0.8OA UCDVA 0.9 UCNVA 0.8

Page 41: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Myopic-NDE

Page 42: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Myopic-NDE

Page 43: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Myopic-NDE

Page 44: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Myopic-DE

Page 45: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Myopic-DE

Page 46: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Myopic-DE

Page 47: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Recommended QRecommended Q--value targetvalue target

•• In In HyperopiaHyperopia::DE: DE: --0.4 NDE: 0.4 NDE: --0.60.6( Augmented effect by ablation pattern)( Augmented effect by ablation pattern)

•• In Myopia:In Myopia:DE: DE: --0.8 NDE: 0.8 NDE: --1.01.0( Reduced effect by ablation pattern)( Reduced effect by ablation pattern)

Page 48: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

HypermetropicHypermetropic case with modified case with modified nomogramnomogram

•• Female 48 yearsFemale 48 years•• PreopPreop: : OD +1.25 OD +1.25 --0.75 X 120 DE0.75 X 120 DE

UCDVA 0.5 BCDVA 0.9UCDVA 0.5 BCDVA 0.9OS +2.0 OS +2.0 --1.0 X 60 NDE1.0 X 60 NDEUCDVA 0.4 BCDVA 0.8UCDVA 0.4 BCDVA 0.8

•• PostopPostop: : OD +0.25 OD +0.25 --0.25 X 180 0.25 X 180 UCDVA 0.9 BCDVA 0.9UCDVA 0.9 BCDVA 0.9OS OS --1.251.25UCDVA 0.6 BCDVA 0.9UCDVA 0.6 BCDVA 0.9

OA UCDVA 0.9 UCNVA 0.9OA UCDVA 0.9 UCNVA 0.9

Page 49: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case with modified nomogram-DE

Page 50: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case with modified nomogram-DE

Page 51: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case with modified nomogram-DE

Page 52: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case with modified nomogram-NDE

Page 53: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case with modified nomogram-NDE

Page 54: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Hyperopic case with modified nomogram-NDE

Page 55: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

CONCLUSIONSCONCLUSIONS

•• An adequate uncorrected far and near vision can be An adequate uncorrected far and near vision can be achieved with an increase of depth of field with Qachieved with an increase of depth of field with Q--adjustment and adjustment and monovisionmonovision. Q. Q--adjustment with adjustment with monovisionmonovision is safe and effective in correcting is safe and effective in correcting presbyopiapresbyopia ..

•• Shifting QShifting Q--value to negative side:value to negative side:* Overcorrect in * Overcorrect in myopesmyopes and and undercorrectundercorrect in in

hyperopeshyperopes ( as ( as AssisAssis, user, user’’s meeting 2009).s meeting 2009).* Resulting Q* Resulting Q--value is value is undertargetundertarget in in myopesmyopes and and

overtargetovertarget in in hyperopeshyperopes. .

Page 56: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

Course in AAO 2010, ChicagoPresbyopia, Corneal Approach: State of the

Art

Moderator: Mounir Khalifa, MD, PhDFaculty: Ronald Krueger, MD

Gustavo Tamayo, MDTarek A. Wahab, MDJorge Alio, MD, PhD

Page 57: Asphericity and Q Adjustments in Treating Presbyopia · Asphericity and Q Adjustments in Treating Presbyopia Mounir Khalifa Prof. of Ophthalmology, Tanta University Horus Vision Correction

THANK YOU