Changes in visual acuity and corneal aberrations after presbyopia correction using micro-monovision multifocal bi-aspheric ablation: six-month results

To assess visual outcomes and corneal aberration changes following micro-monovision multifocal bi-aspheric ablation (PresbyMax monocular) for presbyopia correction. 25 patients (50 eyes) underwent PresbyMAX monocular treatment. Pre and postoperative evaluations (1 week, 1, 3, and 6 months) included uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance visual acuity (CDVA). Corneal aberration and Strehl ratio (SR) were analyzed within 3-mm and 6-mm zones. The National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25) was used to assess visual function preoperatively and at 6 months postoperatively. At 6 months, binocular UDVA and UIVA were 0 (− 0.1, 0) logMAR and − 0.1 (− 0.1, 0) logRAD, respectively. Spectacle independence reached 96%, with 96%, 100%, and 96% achieving UDVA ≥ 0.1 logMAR, UIVA ≥ 0.1 logRAD, and UNVA ≥J1. No eyes lost corrected distance visual acuity. In non-dominant eyes, 3-mm corneal zones exhibited negative shifts in fourth-order spherical aberration (Z₄⁰) and sixth-order spherical aberration (Z₆⁰) (both p < 0.001). In 6-mm corneal zones, Z₄⁰ exhibited no significant change; however, compared to the dominant eye, it was significantly more negative (p < 0.001). Z₆⁰ increased positively with a statistically significant difference (p < 0.001). NEI-VFQ-25 scores improved from 74.63 (71.70, 81.81) to 91.15 (85.23, 93.08) (p < 0.001). The PresbyMAX protocol enhances near vision by strategically manipulating aberrations to increase depth of focus in the non-dominant eye, while the dominant eye maintains distance and intermediate vision. This synergistic binocular approach achieves satisfactory full-range vision, resulting in a 96% spectacle independence rate and high patient satisfaction. ChiCTR2300074821, registration date 2023-08-17.