Multifocal LASIK for Correction of Multifocal LASIK for Correction of Presbyopia with a Variable Spot Presbyopia with a Variable Spot

Scanning Excimer Laser Scanning Excimer Laser

Jay Fiore MD, Eric Donnenfeld MD, Jay Fiore MD, Eric Donnenfeld MD,

Hank Perry MD, Dana Morschauser ODHank Perry MD, Dana Morschauser OD

Ophthalmic Consultants of Long IslandOphthalmic Consultants of Long Island

TLC Laser Eye CenterTLC Laser Eye Center

Dr. Donnenfeld is a consultant for Allergan , Alcon, AMO, Aquesys, Advanced Vision Research,

Bausch & Lomb, CRST, Eyemaginations, Glaukos, Inspire, Lacripen, Odyssey, Pfizer,

QLT, Sirion, TLC Laser Centers, TrueVision, and Wavetec

Dr. Perry is a consultnt for Allergan, Inspire

Multifocal Corneal AblationMultifocal Corneal Ablation Multifocal corneal ablation is not currently Multifocal corneal ablation is not currently

available in the United States although it has available in the United States although it has been investigated in other parts of the world.been investigated in other parts of the world.

The purpose of this study is to evaluate a The purpose of this study is to evaluate a novel off label technique for performing a novel off label technique for performing a multifocal excimer laser corneal ablation and multifocal excimer laser corneal ablation and to evaluate efficacy and safety.to evaluate efficacy and safety.

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

Hyper-Prolate Aspheric Corneas Hyper-Prolate Aspheric Corneas Create Increased Depth of FieldCreate Increased Depth of Field

Courtesy Theo Seiler

Ophthalmic Consultants of Long Island

CustomVueCustomVueKeratometryKeratometry Cosine Effect – Can Cosine Effect – Can

be modified to be modified to produce a prolate produce a prolate peripheral ablation peripheral ablation during excimer laser during excimer laser photoablationphotoablation

Steeper corneas Steeper corneas receive additional receive additional pulses in the pulses in the periphery periphery

Methodology to Increase Negative Methodology to Increase Negative Spherical Aberration and Depth of FieldSpherical Aberration and Depth of Field

Treat Dominant eye with traditional custom ablation Treat Dominant eye with traditional custom ablation zone and keratometryzone and keratometry

Treat Non-Dominant eye (Prolate eye) with custom Treat Non-Dominant eye (Prolate eye) with custom ablation and:ablation and: Reduce optical zone/ablation zone from 6.0/8.0 mm to Reduce optical zone/ablation zone from 6.0/8.0 mm to

5.5/7.5 mm 5.5/7.5 mm

Increase programmed keratometry by 15 dioptersIncrease programmed keratometry by 15 diopters

Methods-22 patients with a mean age of 49.2 (range 43-Methods-22 patients with a mean age of 49.2 (range 43-55) and a mean myopia of – 4.35 D underwent bilateral 55) and a mean myopia of – 4.35 D underwent bilateral LASIK with the non-dominant eye receiving a LASIK with the non-dominant eye receiving a hyperprolate ablation. Patients were followed at 1 hyperprolate ablation. Patients were followed at 1 week and 1 month week and 1 month

True K Values in a Surgical Treatment Plan

Increased K Values Create a Hyperprolate Ablation

Post-Op Spherical Aberration 1 monthPost-Op Spherical Aberration 1 month

P=.820

mic

rons

Post-Op Distance BCVA 1 MonthPost-Op Distance BCVA 1 Month

P>0.05

Best Corrected DistanceBest Corrected Distance Near 0.33 cm at 1 Month Near 0.33 cm at 1 Month

P=.016

P=.044

All patients under age 47

Best Corrected Distance Best Corrected Distance Intermediate 0.5 cm at 1 MonthIntermediate 0.5 cm at 1 Month

P=.018

P=.007

Conclusions:Conclusions:Hyperprolate Peripheral AblationHyperprolate Peripheral Ablation

2-3 line increase in near and intermediate 2-3 line increase in near and intermediate visionvision

Minimal loss of distance UCVA or BCVAMinimal loss of distance UCVA or BCVA

No need to doublecardNo need to doublecard

No risk of decentered ablation No risk of decentered ablation

Long term evaluation with contrast sensitivity Long term evaluation with contrast sensitivity is requiredis required