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

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.

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

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  1. 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

  2. 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.

  3. ≈ -1.50D 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

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

  5. 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

  6. True K Values in a Surgical Treatment Plan

  7. Increased K Values Create a Hyperprolate Ablation

  8. Post-Op Spherical Aberration 1 month microns P=.820

  9. Post-Op Distance BCVA 1 Month P>0.05

  10. Best Corrected Distance Near 0.33 cm at 1 Month P=.044 P=.016 All patients under age 47

  11. Best Corrected Distance Intermediate 0.5 cm at 1 Month P=.007 P=.018

  12. Conclusions:Hyperprolate 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

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