Presbyopia Treatment by Monocular Peripheral PresbyLASIK

PURPOSE: To investigate monocular peripheral presbyLASIK on the non-dominant eye with distance-directed monofocal refractive surgery on the dominant eye in treating presbyopia. METHODS: One hundred three patients underwent treatment with a VISX S4 system and follow-up from 1.1 to 3.9 years (mean 27.4 months). Average patient age was 53.3 years. Preoperative refraction ranged from -9.75 to +2.75 diopters (D). Non-dominant eyes underwent peripheral presbyLASlK--an aspheric, pupil-size dependent LASIK to induce central corneal relative flattening and peripheral corneal relative steepening. Dominant eyes underwent monofocal refraction-based LASIK (75.8%), wavefront-guided LASIK, limbal relaxing incisions, or no treatment to optimize distance vision. RESULTS: At final follow-up, 91.3% (94/103) of all patients, 89% (25/28) of hyperopes, and 92% (69/75) of myopes reported complete spectacle independence and 7.8% (8/103) used spectacles for less than 1 hour per week. Distance unaided visual acuity was at least 20/20 in 67.9% (19/28) of hyperopes and 70.7% (53/75) of myopes, at least 20/20 at 80 cm in 85.7% (24/28) of hyperopes and 84% (63/75) of myopes, and at least 20/20 at 40 cm in 71.4% (20/28) of hyperopes and 65.3% (49/75) of myopes, PresbyLASIK increased overall higher order aberrations similarly to refraction-based LASIK for myopes but to a greater extent in hyperopic cases. PresbyLASIK WaveScan spherical equivalent refraction was stable in myopes but migrated an average +0.31 D in hyperopes over the follow-up period. CONCLUSIONS: Monocular peripheral presbyLASIK is a valuable option for presbyopic patients considering refractive surgery.