Multifocal LASIK for Correction of Presbyopia with a Variable Spot Scanning Excimer Laser

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Multifocal LASIK for Correction of Presbyopia
with a Variable Spot Scanning Excimer Laser

• Jay Fiore MD, Eric Donnenfeld MD,
• Hank Perry MD, Dana Morschauser OD
• Ophthalmic Consultants of Long Island
• TLC Laser Eye Center

Dr. Donnenfeld is a consultant for Allergan ,
Alcon, AMO, Aquesys, Advanced Vision Research,
Bausch Lomb, CRST, Eyemaginations, Glaukos,
Inspire, Lacripen, Odyssey, Pfizer, QLT, Sirion,
TLC Laser Centers, TrueVision, and Wavetec Dr.
Perry is a consultnt for Allergan, Inspire
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Multifocal Corneal Ablation

• Multifocal corneal ablation is not currently
  available in the United States although it has
  been investigated in other parts of the world.
• The purpose of this study is to evaluate a novel
  off label technique for performing a multifocal
  excimer laser corneal ablation and to evaluate
  efficacy and safety.

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Hyper-Prolate Aspheric Corneas Create Increased
Depth of Field
The combination of mono-vision (central rays are
focused in front of the retina) and a
hyper-prolate shape of the cornea (peripheral
rays are focused behind the central rays) creates
a larger depth of field.
Courtesy Theo Seiler
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CustomVueKeratometry

• Cosine Effect Can be modified to produce a
  prolate peripheral ablation during excimer laser
  photoablation
• Steeper corneas receive additional pulses in the
  periphery

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Methodology to Increase Negative Spherical
Aberration and Depth of Field

• Treat Dominant eye with traditional custom
  ablation zone and keratometry
• Treat Non-Dominant eye (Prolate eye) with custom
  ablation and
• Reduce optical zone/ablation zone from 6.0/8.0 mm
  to 5.5/7.5 mm
• Increase programmed keratometry by 15 diopters
• Methods-22 patients with a mean age of 49.2
  (range 43-55) and a mean myopia of 4.35 D
  underwent bilateral LASIK with the non-dominant
  eye receiving a hyperprolate ablation. Patients
  were followed at 1 week and 1 month

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True K Values in a Surgical Treatment Plan
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Increased K Values Create a Hyperprolate Ablation
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Post-Op Spherical Aberration 1 month
microns
P.820
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Post-Op Distance BCVA 1 Month
Pgt0.05
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Best Corrected Distance Near 0.33 cm at 1 Month
P.044
P.016
All patients under age 47
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Best Corrected Distance Intermediate 0.5 cm at 1
Month
P.007
P.018
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ConclusionsHyperprolate Peripheral Ablation

• 2-3 line increase in near and intermediate vision
• Minimal loss of distance UCVA or BCVA
• No need to doublecard
• No risk of decentered ablation
• Long term evaluation with contrast sensitivity is
  required