[Visual outcomes and satisfaction-related factors after laser blended vision surgery for myopia with presbyopia]

Objective: To evaluate the visual acuity, refractive predictability, and vision-related quality of life in patients with myopia and presbyopia 3 months after laser blended vision (LBV) surgery, and to analyze factors associated with postoperative dissatisfaction. Methods: This was a retrospective case series study. Clinical data were collected from 43 patients (86 eyes) who underwent LBV surgery for presbyopia correction at Zhongshan Ophthalmic Center, Sun Yat-sen University, from February 2025 to November 2025 and completed the postoperative 3-month follow-up. There were 21 males (48.8%) and 22 females (51.2%), with a mean age of (44.21±2.20) years. Uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) (both converted to the logarithm of the minimum angle of resolution, logMAR), manifest refraction, postoperative satisfaction scores, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) scores were recorded before and after surgery. Postoperative visual acuity, refractive predictability, and vision-related quality of life were analyzed. Patients were divided into a satisfied group and a dissatisfied group according to satisfaction scores. The logistic regression was used to identify factors associated with postoperative dissatisfaction, with results expressed as odds ratio (OR) and 95% confidence interval (CI). Results: At 3 months postoperatively, binocular UDVA and UNVA were -0.07±0.08 and 0.07±0.10, respectively. The postoperative spherical equivalent was (-0.13±0.34) D in dominant eyes and (-1.06±0.39) D in non-dominant eyes. All patients reported no need for regular presbyopia-correcting spectacles, and 32 patients (74.4%) were in the satisfied group. The scores of general vision, ocular discomfort, near activities, mental health, role difficulties, and driving in the satisfied group were significantly higher than those in the dissatisfied group (all P<0.05). Multivariate Firth-corrected logistic regression analysis showed that each 1-mm increase in axial length was associated with 3.31-fold higher odds of postoperative dissatisfaction (OR=3.31, 95%CI: 1.11-16.18, P=0.029). By contrast, elevated tear film break-up time (OR=0.74, 95%CI: 0.47-0.98, P=0.034) and elevated negative relative accommodation (OR=0.10, 95%CI: 0.01-0.51, P=0.003) were both associated with lower odds of postoperative dissatisfaction. Conclusions: LBV surgery provided favorable UNVA and UDVA and good refractive predictability, with a high level of spectacle independence and overall satisfaction in patients with myopia and presbyopia. The dissatisfied patients had lower vision-related quality of life scores in near activities and role difficulties. Longer axial length was associated with an increased risk of postoperative dissatisfaction, whereas better tear film stability and greater negative relative accommodation were associated with a reduced risk, suggesting that preoperative assessment of the ocular surface status and accommodative function may be useful for patient selection and perioperative management.