LASIK for Hyperopic Astigmatism and Presbyopia Using Micro-monovision With the Carl Zeiss Meditec MEL80 Platform

Purpose: To evaluate the monocular and binocular outcomes of LASIK for a micro-monovision protocol for the correction of hyperopic astigmatism and presbyopia. Methods: A prospective non-comparative case series included 258 eyes of 129 consecutive patients with hyperopic astigmatism and presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the Carl Zeiss Meditec MEL80 excimer laser. The target refraction was plano for distance eyes (dominant eye) and between −1.00 and −1.50 diopters (D) for near eyes. Patients were followed for 1 year. Results: Mean attempted spherical equivalent refraction (SE) correction was +2.54±1.16 D (range: +0.25 to +5.75 D). Mean attempted cylinder was −0.52±0.49 D (range: −0.00 to −3.25 D). Median age was 56 years (range: 44 to 66 years). Median follow-up was 12.5 months (range: 3.3 months early retreatment to 18.2 months). The retreatment rate was 22%. Outcome measures after all treatments were as follows. Mean deviation from the intended SE correction was +0.09±0.48 D, with 79% of eyes within ±0.50 D and 95% within ±1.00 D. The cylinder correction ratio was 1.23±0.63 and the error ratio was 0.67±0.65. Of the distance eyes, 86% achieved uncorrected visual acuity of 20/20 and 100% achieved 20/40. Binocularly, 95% of patients achieved 20/20 and 100% achieved 20/40. Eighty-one percent of patients could read J2 and 100% could read J5. Binocularly, 95% of patients achieved 20/20 and could read J5. No eyes lost 2 or more lines of best spectacle-corrected visual acuity. A statistically significant increase was noted in contrast sensitivity at 3 and 6 cycles per degree (cpd), with no reduction at 12 and 18 cpd. The average change in refraction between 3 months and 1 year was +0.11±0.36 D with a change of >1.00 D in 2.6% of eyes. Conclusions: This hyperopic micro-monovision protocol was a well-tolerated and effective procedure for treating patients with presbyopia in moderate to high hyperopia with corrections ranging up to +5.75 D. Contrast sensitivity was improved and the distance vision of near eyes was found to contribute positively to binocular distance vision compared to distance eyes monocularly. J Refract Surg . 2009;25:37–58.