Twenty-Four-Month Dynamic Range of Visual Outcomes After Laser Anterior Ciliary Excision Procedure
Purpose
To evaluate accommodative benefits for dynamic range of vision at near (40 cm) and intermediate (60cm) visual performance after Laser Anterior Ciliary Excision procedure (LaserACE).
Methods
This prospective single arm design clinical trial evaluated the laserACE procedure results over 24 months. 17 subjects >40 year of age demonstrating loss of accommodative function, good uncorrected distance vision with less than 1.0D of refractive astigmatism, and otherwise healthy eyes were evaluated. Laser anterior ciliary excision was performed using a 2.94um Er:Yag laser in four quadrants on the sclera over the ciliary muscle in 3 key zones to improve biomechanical accommodative forces. Primary study targets were improvement in UIVA/DCIVA (60 cm) and UNVA/DCNVA (40 cm) with no significant loss of UDVA/CDVA.
Results
All patients achieved some improvement of near and intermediate vision. An average of 2-4 lines of improvement of reading vision was found. Postoperatively, DCIVA was 20/30 or better in 100% of subjects; 71% were 20/25 and 57% were 20/20. DCNVA was 20/30 or better in 71% of subjects; 43% were 20/25 and 14% were 20/20. No statistical change was noted in DCVA Postoperatively. Postoperatively, UIVA was 20/30 or better in 86% of subjects; 71% were 20/25 and 71% were 20/20. UNVA was 20/30 or better in 86% of subjects; 71% were 20/25 and 14% were 20/20. No statistical change was noted in UDVA postoperatively. Average added accommodative ability was approximately 1.5D, which was clinically significant. Stereopsis improved from an average of 75.77” to 60” which was clinically significant.
Conclusion
LaserACE performed using the VisioLite Er:Yag laser appears to be a safe and effective procedure for restoring range of visual performance for near and intermediate visual tasks without compromising UDVA/CDVA or binocularity. Patient satisfaction was high postoperatively, and was sustained over the 24 months.