Abstract： Objective: To evaluate the effectiveness of an improved monocular ablation profile procedure with Q-factor modulation treatment in myopic eyes of presbyopic patients. Methods: This was a retrospective case control study. Thirty-four presbyopic patients underwent an improved monocular ablation profile procedure with Q-factor modulation for the nondominant eyes: Target Q-factor of 0.3-0.5 more negative than the preoperative Q-factor, and a target refractive error of -1.00- -0.25 D. Another 43 presbyopic patients who underwent monocular treatment for the nondominant eyes during the same period were paired for age and refractive state. The dominant eyes were fully corrected. The uncorrected distance visual acuity (NCDVA), intermediate distance visual acuity (NCIVA), and near distance visual acuity (NCNVA) of the nondominant eye and both eyes were recorded. The corneal curvature in a 3 mm radius, the Q-factor of the corneal surface, total aberrations, higher- and lower-order aberrations, spherical aberrations, corneal spherical aberrations, defocus and coma aberrations were recorded. Independent sample t-test were used to compare the continuous variables between two groups, and Spearman correlation test were used to show the correlation between NCNVA and defocus, postoperative Q value, and the pupil diameter changes. Results: Three months after surgery, NCNVA of the improved monocular ablation group was better than that of the control group (t=0.597, P=0.021), but the differences in NCDVA and NCIVA were not statistically significant. For both eyes, the NCNVA (LogMAR) of 93% of patients in the improved monocular ablation group was 0 or better, while the percentage in the control group was 86% (χ2 =27.127, P<0.001). Compared to the control group, the total aberrations, lower-order aberrations, corneal spherical aberrations, and defocus were higher in the monocular ablation profile group (t=-2.210, P=0.032; t=-2.135, P=0.038; t=-2.108, P=0.038, t=-2.190, P=0.034). For all 77 patients, NCNVA of the nondominant eye was negatively correlated with defocus, postoperative Q-factor of the anterior cornea and the change in pupil diameter when accommodation occurred (r1=-0.251, P1=0.028; r2=-0.543, P2<0.001; r3=-0.417, P3<0.001). Conclusions: The improved monocular ablation profile with Q-factor modulation treatment in myopic eyes of presbyopic patients can improve near vision without compromising far vision. The modulation of the Q-factor to a more negative value can improve near visual acuity by increasing central corneal curvature, defocus, and corneal spherical aberrations.
Jain S, Arora I, Azar DT. Success of monovision in presbyopes: Review of the literature and potential applications to refractive surgery. SurvOphthalmol, 1996, 40(6): 491-499. DOI: 10.1016/ s0039-6257(96)82015-7.
[2]
Rouimi F, Ouanezar S, Goemaere I, et al. Presbyopia management with Q-factor modulation without additive monovision: One-year visual and refractive results. J Cataract Refract Surg, 2019, 45(8): 1074-1083. DOI: 10.1016/j.jcrs.2019.02.039.
[3]
González-Méijome JM, Villa-Collar C, Montés-Micó R, et al. Asphericity of the anterior human cornea with different corneal diameters. J Cataract Refract Surg, 2007, 33(3): 465-473. DOI: 10.1016/j.jcrs.2006.11.004.
[4]
Amigo A, Bonaque S, López-Gil N, et al. Simulated effect of corneal asphericity increase (Q-factor) as a refractive therapy for presbyopia. J Refract Surg, 2012, 28(6): 413-418. DOI: 10.3928/1081597X-20120518-04.
[5]
Wang Yin GH, McAlinden C, Pieri E, et al. Surgical treatment of presbyopia with central presbyopickeratomileusis: One-year results. J Cataract Refract Surg, 2016, 42(10): 1415-1423. DOI: 10.1016/j.jcrs.2016.07.031.
Erickson P, McGill EC. Role of visual acuity, stereoacuity, and ocular dominance in monovision patient success. Optom Vis Sci, 1992, 69(10): 761-764. DOI: 10.1097/00006324-199210000- 00003.
[8]
Han J, Hong S, Lee S, et al. Changes in fusionalvergence amplitudes after laser refractive surgery for moderate myopia. J Cataract Refract Surg, 2014, 40(10): 1670-1675. DOI: 10.1016/ j.jcrs.2014.01.043.
[9]
Luger Michiel HA, Mc Alinden Colm, Buckhurst Philip J, et al. Presbyopic LASIK using hybrid bi-aspheric micro-monovision ablation profile for presbyopic corneal treatments. Am J Ophthalmol, 2015, 160: 493-505. DOI: 10.3928/1081597X- 20200102-01.10.
[10]
Gordon Michael. Presbyopia corrections with the WaveLight ALLEGRETTO: 3-month results. J Refract Surg, 2010, 26(10): S824-S826. DOI: 10.3928/1081597X-20100921-10.
[11]
Luger MH, Ewering T, Arba-Mosquera S. One-year experience in presbyopia correction with biaspheric multifocal central presbyopia laser in situ keratomileusis. Cornea, 2013, 32(5): 644-652. DOI: 10.1097/ICO.0b013e31825f02f5.
[12]
Cheng AC, Lam DS. Monovision LASIK for pre-presbyopic and presbyopic patients. J Refract Surg, 2005, 21(4): 411-412; author reply 412.
[13]
Jain S, Ou R, Azar DT. Monovision outcomes in presbyopic individuals after refractive surgery. Ophthalmology, 2001, 108(8): 1430-1433. DOI: 10.1016/s0161-6420(01)00647-9.
[14]
Becker KA, Jaksche A, Holz FG. PresbyLASIK: Treatment approaches with the excimer laser. Ophthalmologe, 2006, 103(8): 667-672. DOI: 10.1007/s00347-006-1391-y.
[15]
Telandro A. Pseudo-accommodative cornea: A new concept for correction of presbyopia. J Refract Surg, 2004, 20(5 Suppl): S714-717.
浙公网安备 33030202001892号