Presbyopia Treatment by Monocular
Peripheral PresbyLASIK
Robert Leonard Epstein, MD, MSEE; Mark Andrew Gurgos, COA

ABSTRACT
PURPOSE: To investigate monocular peripheral presby-
LASIK on the non-dominant eye with distance-directed
monofocal refractive surgery on the dominant eye in
treating presbyopia.
METHODS: One hundred three patients underwent
treatment with a VISX S4 system and follow-up from
1.1 to 3.9 years (mean 27.4 months). Average patient
age was 53.3 years. Preoperative refraction ranged
from
9.75 to 2.75 diopters (D). Non-dominant eyes
underwent peripheral presbyLASIK—an aspheric, pupil–
size dependent LASIK to induce central corneal relative
fl attening and peripheral corneal relative steepening.
Dominant eyes underwent monofocal refraction-based
LASIK (75.8%), wavefront-guided LASIK, limbal relaxing
incisions, or no treatment to optimize distance vision.
RESULTS: At fi nal follow-up, 91.3% (94/103) of all patients,
89% (25/28) of hyperopes, and 92% (69/75) of
myopes reported complete spectacle independence and
7.8% (8/103) used spectacles for less than 1 hour per
week. Distance unaided visual acuity was at least 20/20
in 67.9% (19/28) of hyperopes and 70.7% (53/75) of
myopes, at least 20/20 at 80 cm in 85.7% (24/28) of
hyperopes and 84% (63/75) of myopes, and at least
20/20 at 40 cm in 71.4% (20/28) of hyperopes and
65.3% (49/75) of myopes. PresbyLASIK increased overall
higher order aberrations similarly to refraction-based
LASIK for myopes but to a greater extent in hyperopic
cases. PresbyLASIK WaveScan spherical equivalent refraction
was stable in myopes but migrated an average
0.31 D in hyperopes over the follow-up period.
CONCLUSIONS: Monocular peripheral presbyLASIK is
a valuable option for presbyopic patients considering
refractive surgery. [J Refract Surg. 2009;25:516-523.]
doi:10.3928/1081597X-20090512-05 (Read More)

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Multifocal LASIK is the primary procedure we use for freedom from glasses for people age 48 and over. Multifocal LASIK is an advance over monovsion. The purpose of monovision is to provide visual clarity at long distance and at a single distance up close. The effect of monovsion is useful but expires with age. Multifocal LASIK provides a broader range of focus. As with monovision, the dominant eye is set for distance. But with multifocal LASIK, the non-dominant eye is made bifocal by a process called presbyLASIK. For people who do not have cataracts it is a reasonable, less invasive, and less expensive alternative to multifocal lens implants for the purpose of getting rid of bifocals. Published data show that over 90% of multifocal lasik patients at an average age of 53 years old became completely free of the need for any glasses The effect is adjustable and reversable if needed. . Results have been long lasting and we have been performing the procedure since 2003. People who already had cataract surgery and now want to be free of glasses may consider multifocal LASIK. To learn more, download the brochure below. (Read More)

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