Varifocal Versus Monofocal LASIK in Presbyopic Hyperopic Eyes

To compare varifocal (SupraCor; Technolas Perfect Vision GmbH, Munich, Germany) to monofocal (Zyoptix TissueSaving; Bausch & Lomb, Rochester, NY) LASIK in patients with hyperopic presbyopia.

In this prospective, non-randomized, comparative case series, consecutive patients with hyperopia, presbyopia, and emmetropia as target refraction were bilaterally treated with varifocal (8 patients) or monofocal (7 patients) LASIK. The study was designed for 35 patients, but was terminated early after interim analysis. Outcomes (preoperative and 1 day, 1 week, 1 month, and 3 months postoperative) were: monocular and binocular uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), low-contrast UDVA and CDVA, efficacy, and safety.

Preoperative data were similar in both groups. Monocular and binocular UNVA were not significantly different between both groups at any follow-up visit. At 3 months, mean monocular UNVA was 0.40 logMAR in both groups. Monocular DCNVA and binocular CDVA were not significantly different between groups. Monocular mean CDVA was 0.00 ± 0.06 logMAR after varifocal LASIK and -0.06 ± 0.04 logMAR after monofocal LASIK. The efficacy index was 0.9 after vari-focal LASIK and 0.88 after monofocal LASIK (not significant). The safety index was 1.08 after varifocal LASIK and 1.125 after monofocal LASIK (not significant).

With emmetropia as target refraction, varifocal ablations yielded no additional benefit compared to monofocal ablations in hyperopic presbyopic LASIK. The authors speculate that epithelial remodeling masks the impact of a varifocal ablation pattern and that a myopic postoperative refraction (modified monovision) may be necessary to further improve near and intermediate vision. These results demonstrate the value of a control group in studies evaluating presbyopia corrections. [J Refract Surg. 2019;35(7):459-466.].