1. Laser Thermal Keratoplasty in Patients with Hyperopia of Presbyopic Age Alexander V. Doga, MD, PhD, DSc, Alexander A. Shpak, MD, PhD, DSc, Irina A. Mushkova, MD, PhD, Suzy A. Antonian, MD The S.N. Fyodorov Eye Microsurgery Federal State Institution Moscow, Russian Federation

2. Purpose – to assess the long-term efficacy and safety of LTK for hyperopia correction in patients of presbyopic age Methods Methods Laser device «ОКО-1» (Russia) infrared Ho:YAG laser infrared Ho:YAG laser wavelength : 2.12 microns wavelength : 2.12 microns Е: 130 – 180 mJ Е: 130 – 180 mJ irradiation period – 0.5 sec. irradiation period – 0.5 sec.

3. Subjects Accommodative amplitude: 0,75 - 1,5 D (mean 1,24±0,27 D) 27 patients (54 eyes) I group II group 25 patients (50 eyes) Target refraction: low M Target refraction:Em Target refraction: Em Accommodative amplitude: 1,75 - 2,75 D (mean 2,01±0,29 D) Age: 43-61years SE of refraction: 1,0-3,5 D (mean 2,16±0,97 D ) Age : 41-58 years SE of refraction: 1,25-3,0 D (mean 2,26±0,81 D )

4. Schematic view of the operation Surgical procedure Double-ring checkerboard pattern of 24 coagulation spots Laser energy: I group: Е 160-180 mJ II group: Е 130-150 mJ

5. Results 1 day3 days Stretch lines 6 months3 years

6. Dynamics of refraction

7. Dynamics of uncorrected visual acuity Distance Near

8. Results Group 1: Group 1: * uncorrected distance VA did not change significantly * uncorrected distance VA did not change significantly * uncorrected near VA improved by 5 lines * uncorrected near VA improved by 5 lines Group 2: Group 2: * uncorrected distance VA improved by 4 lines * uncorrected distance VA improved by 4 lines * uncorrected near VA improved by 2 lines * uncorrected near VA improved by 2 lines * the presbyopic correction was reduced from +3.71±1.07 to +1.86±0.67 * the presbyopic correction was reduced from +3.71±1.07 to +1.86±0.67

9. Presbyopic correction significantly reduced !! No asthenopic symptoms in the two groups post-op! II group For near For near vision: 15% of patients For far For far vision: 26% of patients Pre-op – glasses for near vision: 100% of the patients Pre-op – glasses for far vision: 87% of the patients Spectacle correction I group Post-opPost-op For near For near vision: 100% of patients For far For far vision: 0% of patients

10. Conclusions 1. Hyperopia correction in patients of presbyopic age by contact holmium:YAG LTK is safe and effective. 2. Pre-op level of amplitude of accommodation provides important data for better planning of the operation in presbyopic patients.