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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Robert L. Epstein, MD FACS (Read More)

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