Improving near vision in presbyopic eyes by selective treatment of high-order aberrations

PURPOSE: Evaluation of improving near vision in presbyopic patients with low to moderate myopia with selective treatment of high-order aberrations (HOAs) using the ORK-CAM software aberrometer and a SCHWIND ESIRIS excimer laser. In this study, all HOAs except vertical coma were treated and the effect on near visual function was evaluated. SETTING: Horus Vision Correction Center, Alexandria, Egypt. METHODS: Twenty-six presbyopic patients (52 eyes) with low to moderate myopia were divided into two groups, A and B. The ORK-CAM software aberrometer was used in both groups to measure HOAs and design wavefront-guided treatment. All included eyes had total coma >0.2 μm. The Moria M2 mechanical microkeratome was used for flap making in both groups. Wavefront-guided laser-assisted in situ keratomileusis using ESIRIS laser was done for all eyes. In Group A (30 eyes) all HOAs were treated. In Group B (22 eyes) vertical coma was left untreated. Postoperative uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), uncorrected near acuity (UCNA), distance corrected near acuity (DCNA), best corrected near acuity with addition for near vision (BCNA), manifest refractive spherical equivalent (MRSE), HOAs, and contrast sensitivity for both groups were done preoperatively and at 3 months postoperatively. RESULTS: Mean age was 47.46 and 45.2 years for groups A and B, respectively. Mean preoperative MRSE was −2.37 and −2.87 D and mean preoperative total HOAs was 0.35 and 0.38 μm in groups A and B, respectively. There was no significant difference between groups regarding age, sex, preoperative MRSE, and preoperative total HOAs. After 3 months, there was no significant difference between groups in terms of UCVA, BCVA, MRSE, and contrast sensitivity. Analysis of postoperative HOAs showed significant difference in vertical coma between the two groups (P < 0.001). DCNA was significantly better in Group B (P < 0.01). CONCLUSION: Treating low to moderate myopia with wavefront-guided ablation including selective treatment of HOAs might be very useful for improving visual functions. Treating all HOAs but the vertical coma improved uncorrected near acuity in presbyopic patients.