Outcomes After Varifocal LASIK for Hyperopic Presbyopia

Sunday, April 27, 2014: 2:07 PM
Room 154 (Boston Convention and Exhibition Center)
Mohammed S. Rashid, MBChB, FRCOphth, Centre for Sight, West Sussex, United Kingdom
Marcela Espinosa, MD, Centre for Sight, East Grinstead, United Kingdom
Sheraz M. Daya, MD, FACS, Centre for Sight, W. Sussex, United Kingdom

Narrative Responses:

Purpose
To evaluate the safety and efficacy of Supracor™ (Technolas Perfect Vision GmbH) - an excimer laser in situ keratomileusis (LASIK) algorithm for the treatment of hyperopic presbyopia.

Methods
A retrospective evaluation of 57 eyes of 31 consecutive hyperopic presbyopic patients who received Supracor™. Treatment criteria included age ≥46 years, corrected distance visual acuity (CDVA) in each eye of ≥0.2logMAR, manifest refraction spherical equivalent (MRSE) between +0.75 to +4.00D, ≤2.00D of astigmatism, mean keratometry readings of 41.0-45.0D, ability to tolerate a near addition of >+1.75D, a difference between the MRSE and the cycloplegic refraction of ≤0.75D, CCT of ≥500μm and a mesopic pupil of 3.0-6.0mm. Main outcome measures were safety, efficacy (uncorrected DVA and uncorrected reading ability), predictability, stability, patient satisfaction, and functioning at 6 months.

Results
Mean age was 51 years (44-63 years). The mean preoperative MRSE was +1.04D ± 0.70D. At 6 months, 80% of patients had a binocular UDVA of ≥20/20, and 93% had a binocular UDVA of ≥20/25. The mean MRSE was -0.67 ± 0.63D at 1 month, -0.60 ± 0.72D at 3 months and -0.73D ± 0.56D at 6 months. The CDVA was ≥20/20 for 94% of patients and ≥20/25 for 100% of patients. Ninety four percent had an uncorrected reading ability of ≥20/32. No patients required a retreatment to enhance UDVA.

Conclusion
Supracor™ LASIK for hyperopic presbyopia provides a high level of spectacle independence for near vision whilst improving and maintaining good distance vision. The UDVA outcomes could be improved  by a nomogram adjustment to avoid overcorrection. Careful patient selection and counseling is necessary to ensure optimal outcomes and realistic patient expectations.