Near visual acuity and patient-reported outcomes in presbyopic patients after bilateral multifocal aspheric LASIK excimer laser surgery.

PURPOSE: To determine improvement of near visual acuity by bilateral multifocal aspheric LASIK treatments in presbyopic patients. SETTING: Goethe-University, Frankfurt, Germany. DESIGN: Prospective, non-randomized trial. METHODS: Thirty presbyopic patients underwent laser in situ keratomileusis (LASIK) treatment with a multifocal aspheric ablation profile using an excimer laser (PresbyMAX). The first 15 patients received a multifocal aspheric ablation profile combined with micro-monovision. For the consecutive 15 patients, less depth of focus (DOF) was included on the distance eye (hybrid). OUTCOME PARAMETERS: Uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity; manifest refraction spherical equivalent (MRSE); subjective quality of vision; and spectacle independence RESULTS:: Binocular CDVA changed from -0.16+/-0.10 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05+/-0.20 logMAR UDVA and -0.06+/-0.14 logMAR CDVA (p = 0.000, p = 0.001) 1 year postoperatively. Near visual acuity improved from 0.47+/-0.13 logMAR (DCNVA) and 0.48+/-0.26 logMAR (UNVA) to 0.19+/-0.19 logMAR (DCNVA, p<0.001) and 0.05+/-0.15 logMAR (UNVA, p<0.001). The hybrid- and the micro-monovision group did not differ statistically except for a better DCNVA in the micro-monovision patients (0.21+/-0.15 logMAR vs 0.34+/-0.17 logMAR, p=0.034). Of the hybrid- and micro-monovision patients, 21 (72%) and 12 (41%) had a binocular CDVA and UDVA of 20/20 or better, 8 (28%) patients lost 1 line of CDVA, 3 (10%) lost 2 lines, 4 (14%) lost 3, and 2 (7%) lost 4 lines of CDVA. CONCLUSIONS: The PresbyMAX laser seemed to satisfy most of the patients even though they experienced a loss of CDVA. The gain of near visual acuity and therefore reported less need of spectacles appeared to compensate for this loss.