Presbyopia management with Q-factor modulation without additive monovision: One-year visual and refractive results

To analyze refractive results after hyperopic presbyopia surgery by Q-factor modulation without additive monovision.

Quinze-Vingts National Ophthalmology Hospital, Paris, France.

Prospective nonrandomized study.

Forty-five hyperopic presbyopic patients not tolerating monovision were included. The target for the dominant eye was emmetropia, whereas that for the nondominant eye was emmetropia associated with a target Q factor of -0.8. The postoperative follow-up included assessments of spherical equivalent (SE) refraction, monocular and binocular corrected and uncorrected (UDVA) distance visual acuities, and binocular corrected and uncorrected (UNVA) near visual acuities. Corneal pachymetry, topography, aberrometry and an analysis of patient satisfaction were performed at the 12-month examination.

The study comprised 90 eyes of 45 consecutive patients. The mean age at surgery was 53.8 years ± 4.99 (SD). The mean preoperative SE was +2.33 ± 1.16 diopters (D) in the dominant eyes and +2.26 ± 1.17 D in the nondominant eyes. At 12 months postoperatively, 42 patients (93%) had a binocular UDVA of Snellen 20/20 and 37 patients (82%) had a binocular UNVA of Jaeger 2 (Parinaud 3). The mean SE at 12 months was -0.22 ± 0.35 D in the dominant eyes (P < .0001) and -0.83 ± 0.50 D in the nondominant eyes (P < .0001). Two eyes required retreatment. Overall, 39 patients (87%) said that they were satisfied and would recommend the intervention.

The Q-factor modulation without additive monovision aims to compensate for presbyopia by changing the Q factor of the nondominant eye to generate a greater depth of field in hyperopic presbyopic patients who are unable to tolerate monovision. The visual outcomes and quality of vision were satisfactory, and only a few patients required additional correction.