Monovision LASIK in emmetropic presbyopic patients

Figures & data

Table 1 Demographic information

Total participants	294 patients
Female	134 (45.6%)
Age	52.5±4.50 years
Follow-up	30 days±7 days
Dominant/nondominant eyes	9 (3.1%)/285 (96.9%)
Contact lens trial	169 (57.5%)
Ablation profile
Standard	144 (48.9%)
Wavefront-guided	21 (7.14%)
iDesign	129 (43.9%)

Note: 82 patients underwent LASIK in the distance eye for hypermetropia.

Abbreviation: LASIK, laser-assisted in situ keratomileusis.

Table 2 Preoperative and postoperative refraction and acuity data

Measurement	Distant eye		Near eye
	Preoperative, n=80	Postoperative, n=80	Preoperative, n=294	Postoperative, n=294
Sphere (D) Mean ± SD (Range: Min, Max)	+0.96±0.51 (−0.75 to +2.00)	+0.04±0.30 (−0.75 to +1.00)	+0.59±0.50 (−0.75 to +2.00)	−1.76±0.70 (−4.25 to +1.25)
Cylinder (D) Mean ± SD (Range: Min, Max)	−0.45±0.46 (−2.75–0.00)	−0.32±0.32 (−1.50–0.00)	−0.35±0.32 (−1.75–0.00)	−0.46±0.6 (−1.50–0.00)
MSE (D) Mean ± SD (Range: Min, Max)	+0.73±0.57 (−1.625 to +1.75)	−0.05±0.30 (−0.875 to +0.75)	+0.41±0.48 (−1.25 to +1.75)	−1.92±0.71 (−4.63 to +1.00)
Monocular UCVAa (logMAR) Mean ± SD (Range: Min, Max)	0.05±0.07 (−0.08–0.1)	−0.03±0.11 (−0.18–0.4)	−0.004±0.08 (−0.18–0.1)	0.66±0.24 (−0.08–1.3)
Monocular UCNAa (logMAR) Mean ± SD (Range: Min, Max)	0.75±0.27 (0–1.6)	–	0.73±0.27 (0–1.6)	0.18±0.16 (−0.1–0.9)
Monocular CDVAb (logMAR) Mean ± SD (Range: Min, Max)	−0.08±0.04 (−0.18–0)	−0.07±0.05 (−0.18–0.10)	−0.07±0.04 (−0.18–0)	−0.04±0.10 (−0.18–0.9)

Notes:

a Uncorrected distance visual acuity (UCDVA) and uncorrected near visual acuity (UCNA) for near eyes and distance for distance eyes.

b Monocular spectacle-corrected distance visual acuity (CDVA).

Abbreviations: LogMAR, log minimum angle of resolution; MSE, manifest spherical equivalent; Min, minimum; Max, maximum.

Figure 1 Preoperative and postoperative uncorrected near acuity of eyes in patients who underwent near LASIK correction.

Note: Visual acuity was 20/40 or better in 88.9% (n=184) after surgery as compared to 4.7% (n=9) preoperatively.
Abbreviation: LASIK, laser-assisted in situ keratomileusis.

Figure 2 Patient-reported satisfaction with vision before and after undergoing surgery.

Note: Postoperatively, 85.4% (n=251) of patients reported they were satisfied or very satisfied with their vision (P=0.001).

Figure 3 Patient satisfaction with driving and activities of daily living.

Notes: (A) Patient-reported ability with driving before and after surgery. Eighty-six percent of patients (n=194) reported little to no difficulty with driving preoperatively vs 71.1% (n=209) postoperatively (P<0.001). (B) Patient-reported ability to perform distance activities of daily living (before and after surgery). More patients reported little to no difficulty postoperatively than preoperatively (P<0.001). (C) Patient-reported ability to perform near activities of daily living before and after surgery. More patients reporting little to no difficulty postoperatively than preoperatively (P<0.001).

Table 3 Average (±SD) preoperative and postoperative patient-reported visual symptoms

	Any symptom N patients (%)	Glare	Halos	Starbursts	Ghosting
Preop average score N=209	105 (50.2%)	0.32±0.8	0.22±0.7	0.28±0.7	0.22±0.7
Postop average score N=294	193 (65.6%)	1.50±1.6	1.34±1.7	1.43±1.7	0.86±1.4
Change	–	1.21±1.9	1.10±1.8	1.13±1.9	0.69±1.6
Severe symptoms n patients (%)
Preop	2 (0.9%)	1 (0.5%)	0 (0%)	0 (0%)	1 (0.5%)
Postop	60 (20.4%)	19 (6.5%)	20 (6.8%)	30 (10.2%)	14 (4.8%)

Notes: Symptoms were reported on a Likert scale of 0–6, with zero being no symptoms and six being very severe symptoms. The number here represents the average score for all patients before and after surgery, as well as the average change in symptoms. Severe symptoms were defined as a score of 5 or 6 on the scale.

Table 4 Univariate analysis of factors related to postoperative dissatisfaction with vision

Variables	Odds ratio	95% CI	P-value
Age	0.99	0.90–1.10	0.9
Gender
Male (reference)	1	–	–
Female	2.21	0.83–5.85	0.1
Preop visual satisfaction
Dissatisfied (ref)	1	–	–
Neutral	0.46	0.15–1.73	0.3
Satisfied	0.51	0.10–2.21	0.3
Preop visual symptom score	0.80	0.52–1.22	0.3
Preop UCDA (LogMAR)	1.41	0.01–308	0.9
Preop dry score	0.44	0.14–1.40	0.2
Preop MSE	1.36	0.53–3.48	0.5
Preop UCNA	0.14	0.02–1.02	0.05
Postop MSE	0.38	0.21–0.70	0.002
Postop UCNA	4.87	0.21–113	0.9
Postop dry score	1.64	1.25–2.18	<0.001
Postop visual complaints	1.24	1.15–1.34	<0.001
Monovision target	0.57	0.11–3.08	0.5

Note: Statistically significant values shown in bold.

Abbreviations: LogMAR, log minimum angle of resolution; MSE, manifest spherical equivalent; UCDA, uncorrected distance visual acuity; UCNA, uncorrected near visual acuity.

Table 5 Multivariate analysis of factors related to postoperative dissatisfaction with vision

Variables	Odds ratio	95% CI	P-value
Gender
Male (reference)	1	–	0.3
Female	1.95	0.62–6.11
Preop UCNA	0.11	0.01–1.12	0.06
Postop MSE	0.54	0.26–1.13	0.1
Postop dry score	1.26	0.88–1.79	0.2
Postop visual symptoms score	1.18	1.07–1.29	0.001

Note: Statistically significant values shown in bold.

Abbreviations: MSE, manifest spherical equivalent; UCNA, uncorrected near visual acuity.

Figure 4 Patient satisfaction as a function of visual symptom score.