Femtosecond laser-assisted in situ keratomileusis multifocal ablation profile using a mini-monovision approach for presbyopic patients with hyperopia

Purpose: To report the visual outcomes of the femtosecond laser-assisted multifocal aspheric corneal ablation profile using a mini-monovision approach and to evaluate if corneal multifocality was effective, and to report the relative benefits of this approach.

Patients and methods: Bilateral femtosecond laser-assisted in situ keratomileusis using a multifocal aspheric corneal ablation profile was performed on 19 hyperopic patients (38 eyes). They were divided into two groups based on eye dominance: dominant eye (DE) group targeting emmetropia and the nondominant eye (NDE) group targeting -0.5 D slight myopia. The uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and retreatment rates were reported from baseline to 6 months.

Results: The UNVA, UIVA, and UDVA improved significantly in both groups (Kruskal-Wallis test, DE and NDE: P<0.00001, P<0.000005, and P=0.00001, respectively). Corrected distance visual acuity (CDVA) baseline was better in both groups in comparison to UDVA at 6 months (Wilcoxon test, DE: P<0.001, 95% confidence interval (CI) of the median 0.0-0.0 LogMAR and 0.1000-0.1218 LogMAR and NDE: P=0.010, 95% CI of the median 0.0-0.0 LogMAR and 0.00-0.10 LogMAR). There was a significant loss of lines between CDVA baseline and UDVA at 6 months in both groups (DE group: 68% of eyes lost one line or more; NDE group: 58% of eyes lost one line or more). The corrected near visual acuity baseline compared to UNVA at 6 months was not statistically important (Wilcoxon test, DE: P=0.8125, 95% CI of the median 0.0-0.0 LogMAR and 0.0-0.0 LogMAR and NDE: P=0.82, 95% CI of the median 0.0-0.0 LogMAR and 0.0-0.0 LogMAR). The comparison among the UDVA, UIVA, and UNVA between the two groups at baseline and during all follow-ups was not statistically important. Two cases from the DE group were retreated (6%).

Conclusion: Use of this multifocal aspheric corneal ablation profile in patients with hyperopic presbyopia significantly improved UDVA, UIVA, and UNVA. This improvement was due to created multifocality of the cornea. The mini-monovision seems not to affect UDVA, UIVA, and UNVA between the two groups. The retreatment rates at the 6-month evaluation were significantly less in our study when compared with other studies. This method seems to improve UDVA, UIVA, and UNVA but could result in a significant statistical difference between CDVA baseline and UDVA at 6 months that leads to loss of lines in distance vision. Despite promising results, this is a preliminary evaluation of this new profile, and a larger number of eyes are needed to verify visual outcomes, retreatment rates, and safety.