RESULTS OF MULTIFOCAL TREATMENT FOR PRESBYOPIA WITH VISX STAR S4 IR EXCIMER LASER AUTHOR: L. FELIPE VEJARANO, MD. CO – AUTHOR: IYALI CONTRERAS M. FELLOWSHIP. FUNDACION OFTALMOLOGICA VEJARANO POPAYÁN – COLOMBIA AUTHOR: L. FELIPE VEJARANO, MD. CO – AUTHOR: IYALI CONTRERAS M. FELLOWSHIP. FUNDACION OFTALMOLOGICA VEJARANO POPAYÁN – COLOMBIA

PRESBYOPIA Takes us all to the inevitable need of correction or use of glasses in order to be able to see small things, generally after the age of 40 Inherent Pseudo-accomodative properties: 1. Physiological myosis. 2. Against the rule astigmatism. 3. Negative spherical aberration.

We must classify Presbyopic patients not only by their age, but also depending on their refractive defect, in order to select in each case the best procedure with the lowest risk and the best vision we can offer them. PRESBYOPIA

OPTIONS If we want to improve the near and far vision optically, the only solution that seems most logical until now is corneal multifocality. Other Options:  Conductive Keratoplasty.  Monovision.  Intracorneal lens devices (Inlays), placed in the non- dominant eye.  Bilateral corneal multifocality using Excimer Laser.

MULTIFOCALITY USING EXCIMER LASER.  Bases its treatment on optical aberrations  Precise centering according to the corneal and pupilar center, based in the central shift software  Not based on the intra-operative pupilar centering  Create a very small island of near vision, perfectly centered that works better with good illumination, that improves its effect obtaining therefore myosis

RESULTS We started to use the presbyopic software since October 5 th 2006 Based on age and refractive defect, as follow: 40 to 65 years:  Myopic (-0,75 to -3,00): Multifocal treatment with Excimer Laser and its new presbiopic software that will be release  Myopic (Greater than -3,25): Treatment with customized Excimer Laser and mild Hypocorrection  Astigmatic (any degree): Multifocal treatment with Excimer Laser and its new presbiopic software that will be release

RESULTS  Hyperopic (+0,75 to +1,50): Multifocal treatment with Excimer Laser and its new presbiopic software that will be release  Hyperopic (+1,75 to +3,50): Multifocal treatment with Excimer Laser and the currently available software  Hyperopic (Greater than +3,75): Treatment with customized Excimer Laser and mild Hypercorrection

RESULTS A total of 73 eyes of 38 patients  8 men and 30 women 3 monocular, 35 binoculars Range of age between 42 to 69 years old.  Enhancements were made in 1 bilateral and 2 unilateral ptes. (4.10%)  Glasses were formulated only for distance vision in 4 patients (5,47%)  The average measurement used as prognosis of postoperative near vision was taken preoperatively with distant correction plus the addition of diopters; the preoperative average was 20/36, that means Jaeger 2-3

Shows clearly an improvement in both near and far vision without correction, however far vision at 1 week control is quite blurred in all patients even with correction, they loose lines of vision, but this improves completely in the following controls. So there is no reason to be afraid when you notice a decrease vision during initial controls. It also shows that far vision keeps improving as time goes on, there is also a slight decrease in near vision that turns stable after the third month. The controls show that the results still stable through time.

Analyzing these results, one can clearly notice all tables complement each other: refractive defects initially tend to myopic shift which gradually resolves with time reaching a minimal value that does not affect far vision and helps the near vision.

shows that far vision initially is not very good without correction, although the average seems to be better, it improves substantially in the postoperative controls within acceptable levels not only by patients or surgeons, but within the parameters of any other type of Presbyopic surgery.

Something that seems not understandable is the change in the Keratometry, even though the modern automated equipments reads at 2.6 mm of central diameter, we found that the change in Keratometry power does not correspond with the planned refractive defect and the one performed plus the presbiopic correction and physician adjustments, which means that the VISX Multifocality software for Presbyopia really curves ecxactly at the center.