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概要

Stereopsis and Patient Satisfaction in Myopic and Hyperopic Individuals Selecting Monovision Correction by LASIK or LASEK

I Tuwir, C Kirwan, MS Mustafa and M O’Keefe

Purpose: This study was designed to measure binocular function, patient satisfaction and to evaluate postoperative outcomes of presbyopic patients selecting monovision correction either by laser in situ keratomileusis (LASIK) or Laser Assisted Sub-Epithelial Keratomileusis (LASEK). Methods: We carried out a Retrospective chart review of 86 selected patients 40 years and older, treated with refractive laser monovision correction by LASIK or LASEK. Laser was performed with a Baush & Lomb Technolas 217 (Zyoptix or PlanoScan) Excimer laser. All patients had the dominant eye corrected for distance. The parameters used were distance & near corrected visual acuity, manifest refraction before and after surgery and near stereopsis postoperatively. Patient satisfaction was evaluated by questionnaire. Results: Eighty six patients (51 hyperopes, 35 myopes) were included. Hyperopic mean refractive spherical equivalent (MRSE) in the distance-corrected eye was +1.90 ± 0.79 D and for the eye corrected for near vision MRSE +2.62 ± 0.93. Myopic (MRSE) in the distance corrected eye was -4.15 ± 1.06 D and for the eye corrected for near vision MRSE -2.37 ± 1.06 D. All hyperopes and 7 myopes were treated with LASIK and the rest were treated with LASEK. After surgery 94% had distance binocular uncorrected visual acuity of 0.00 logmar or better and 93.2% of the patients had near binocular uncorrected visual acuity of N6 of better. The mean near steroacuity was 248 ± 244S D seconds of arc. All patients chose their dominant eye to be corrected for distance. Of 35 myopes treated one patient underwent enhancement of the near eye to distance vision and one underwent enhancement for near after 4 months. Eighty-two patients were happy with their vision. Sixty-five percent of all patients had a mean near stereoacuity of ≥ 100 seconds of arc. Despite this eighty two patients are happy with their vision, satisfaction graded with a standardized questionnaire. Conclusion: There is no ideal surgical approach to presbyopia. The ideal procedure is still at present monovision after LASIK or LASEK, although it is a long way off reduces stereopsis it results in high satisfaction for both myopic and hyperopic presbyopic individuals.