LASIK for hyperopic astigmatism and presbyopia using micro-monovision with the Carl Zeiss Meditec MEL80 platform

J Refract Surg. 2009 Jan;25(1):37-58. doi: 10.3928/1081597X-20090101-07.


Purpose: To evaluate the monocular and binocular outcomes of LASIK for a micro-monovision protocol for the correction of hyperopic astigmatism and presbyopia.

Methods: A prospective non-comparative case series included 258 eyes of 129 consecutive patients with hyperopic astigmatism and presbyopia who were treated with LASIK-induced micro-monovision. The CRS-Master software was used to generate ablation profiles for the Carl Zeiss Meditec MEL80 excimer laser. The target refraction was piano for distance eyes (dominant eye) and between -1.00 and -1.50 diopters (D) for near eyes. Patients were followed for 1 year.

Results: Mean attempted spherical equivalent refraction (SE) correction was +2.54+/-1.16 D (range: +0.25 to +5.75 D). Mean attempted cylinder was -0.52+/-0.49 D (range: -0.00 to -3.25 D). Median age was 56 years (range: 44 to 66 years). Median follow-up was 12.5 months (range: 3.3 months [early retreatment] to 18.2 months). The retreatment rate was 22%. Outcome measures after all treatments were as follows. Mean deviation from the intended SE correction was +0.09+/-0.48 D, with 79% of eyes within +/-0.50 D and 95% within +/-1.00 D. The cylinder correction ratio was 1.23+/-0.63 and the error ratio was 0.67+/-0.65. Of the distance eyes, 86% achieved uncorrected visual acuity of 20/20 and 100% achieved 20/40. Binocularly, 95% of patients achieved 20/20 and 100% achieved 20/40. Eighty-one percent of patients could read J2 and 100% could read J5. Binocularly, 95% of patients achieved 20/20 and could read J5. No eyes lost 2 or more lines of best spectacle-corrected visual acuity. A statistically significant increase was noted in contrast sensitivity at 3 and 6 cycles per degree (cpd), with no reduction at 12 and 18 cpd. The average change in refraction between 3 months and 1 year was +0.11+/-0.36 D with a change of >1.00 D in 2.6% of eyes.

Conclusions: This hyperopic micro-monovision protocol was a well-tolerated and effective procedure for treating patients with presbyopia in moderate to high hyperopia with corrections ranging up to +5.75 D. Contrast sensitivity was improved and the distance vision of near eyes was found to contribute positively to binocular distance vision compared to distance eyes monocularly.

MeSH terms

  • Adult
  • Aged
  • Astigmatism / physiopathology
  • Astigmatism / surgery*
  • Corneal Topography
  • Dominance, Ocular / physiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperopia / physiopathology
  • Hyperopia / surgery*
  • Keratomileusis, Laser In Situ / instrumentation
  • Keratomileusis, Laser In Situ / methods*
  • Lasers, Excimer / therapeutic use*
  • Male
  • Middle Aged
  • Presbyopia / physiopathology
  • Presbyopia / surgery*
  • Prospective Studies
  • Reoperation
  • Vision, Binocular / physiology*
  • Visual Acuity / physiology