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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.