Incidence and Risk Factors of Accommodative Spasms After LASIK for Hyperopia Correction

To report the incidence of accommodative spasm after laser in situ keratomileusis (LASIK) for hyperopia and to identify potential risk factors.

This monocentric retrospective study included all patients who underwent LASIK for hyperopia. Preoperative and intraoperative variables were recorded to identify factors associated with accommodative spasm. Patients were classified as having accommodative spasm if a postoperative myopic shift was observed in manifest refraction during the first 3 months, whereas cycloplegic refraction showed emmetropia or hyperopia.

A total of 169 eyes of 100 patients were analyzed. At the last visit, the spasm group showed a statistically significant improvement in uncorrected and corrected distance visual acuity compared to the 3-month visit (P < .05). Although an improvement was observed between the 6-month and the last visit, it did not reach statistical significance. Sphere and spherical equivalent values also improved statistically significantly at 3 and 6 months (P < .05), decreasing myopization. The spasm rate was 21.9% (37 eyes) at 3 months after surgery and 5.3% (9 eyes) at the last visit. Logistic regression revealed a statistically significant association between having an accommodative spasm and having a preoperative latent hyperopia greater than 1.25 diopters (odds ratio: 4.227, P = .049).

Twenty percent of patients develop an accommodative spasm after hyperopic LASIK treatment at 3 months after surgery. However, 75% of those spasms resolve between 6 and 12 months after surgery, by either performing vision therapy or simply observing the patient without specific treatment. Uncorrected preoperatively latent hyperopia greater than +1.25 diopters was associated with postoperative accommodative spasm in this cohort.