Bi-aspheric ablation profile for presbyopic hyperopic corneal treatments using AMARIS with PresbyMAX module: Multicentric Study in Spain

This article describes corneal bi-aspheric ablation profiles to treat presbyopia in hyperopic patients. The ablation profile is the PresbyMAX module of the CAM software. The outcomes presented here are for a series of consecutive presbyopic patients treated with LASIK between January 1, 2010 and December 31, 2010 at 4 sites in Spain. All treatments were performed as bilateral simultaneous LASIK. The results using the PresbyMAX showed that it was a well tolerated, safe and effective procedure for the treatment of presbyopia in hyperopia up to +4D. PURPOSE: To analyse simultaneous vision (distance and near) 6-month after bi-aspheric multifocal central presbyLASIK treatments for hyperopia with or without astigmatsm, based on the creation of a central area for near vision and leaving the midperipheral cornea for far vision in hyperopic patients. SETTING: 50 eyes of 25 patients treated with the PresbyMAX technique by Dr. Iribarne, Dr. Juárez, Dr. Orbegozo, and Dr. Saiz at 4 private practices in Spain. METHODS: Patients have been treated for correcting distance ametropiae and alleviating presbyopic symptoms simultaneously. All patients have been treated in Presby Aspheric mode. No eye had previous corneal refractive surgery. Preoperative corneal curvature ranged between 40 D and 48 D, with pachymetry thicker than 500 μm. Preoperative distance best corrected visual acuity (CDVA) was 0.1 logMAR or better, with best corrected near vision (CNVA) of 0.2 logRAD or better. All eyes were assessed up to 6 months postoperatively. RESULTS: 25 patients treated using PresbyMAX software were reviewed. For 22 patients, 6-month follow-up was completed. At 6 months, 80% of patients achieved UDVA 0.1 logMAR or better, 91% patients obtained UNVA 0.1 logRAD or better, and 96% of eyes were within 0.75 diopters (D) of defocus. Postoperative mean spherical equivalent refraction was –0.08±0.34 D. Stability was achieved from the 3-months follow-up. 95% of patients achieved UDVA 0.2 logMAR or better AND UNVA 0.2 logRAD or better. No statistical differences between males/females were found. The mean binocular distance uncorrected visual acuity (UDVA) improved from 0.50±0.13 logMAR to 0.09±0.08 logMAR. The mean binocular near uncorrected visual acuity (UNVA) increased from 0.71±0.10 logRAD to 0.08±0.07 logRAD. CONCLUSIONS: Patient selection and expectation management is essential to achieve patient satisfaction. Even though optically the results are predictable and good, some patients find it difficult to adapt to the compromise, others are dissatisfied by the minor loss of distance VA. In presbyopic patients without symptomatic cataracts, but refractive errors, PresbyMAX® will decrease the presbyopic symptoms and correct far distance refraction in the same treatment offering spectacle free vision in daily life in most of the treated patients. Further investigation is necessary to evaluate the overall benefit of this procedure.