A new method of cornea modulation with excimer laser for simultaneous correction of presbyopia and ametropia

Graefes Arch Clin Exp Ophthalmol. 2012 Nov;250(11):1649-61. doi: 10.1007/s00417-012-1948-1. Epub 2012 Feb 22.


Purpose: To investigate the outcomes of simultaneous correction of presbyopia and ametropia by a bi-aspheric cornea modulation technique, based on the creation of a central area hyperpositive for near vision and leaving the pericentral cornea for far vision in hyperopic, emmetropic, and myopic presbyopic patients.

Setting: Sixty eyes of 30 patients were treated with the PresbyMAX technique by one surgeon (D.U.) at the Eye Hospital Bellevue, Kiel, Germany.

Methods: Twenty eyes with hyperopic presbyopia, 20 eyes with emmetropic presbyopia, and 20 eyes with myopic presbyopia underwent Femto-Lasik, and were assessed up to 6 months postoperatively. All eyes underwent cornea treatment using the PresbyMAX® software, delivering a bi-aspheric multifocal ablation profile developed by SCHWIND eye-tech-solutions (Kleinostheim, Germany). All flaps were created by Ziemer LDV Femtolaser (Port, Switzerland).

Results: The mean binocular distance of uncorrected visual acuity (DUCVA) improved in the hyperopic group from 0.28 ± 0.29 logMAR to -0.04 ± 0.07 logMAR, in the emmetropic group from -0.05 ± 0.07 logMAR to 0.02 ± 0.11 logMAR, and in the myopic group from 0.78 ± 0.27 logMAR to 0.09 ± 0.08 logMAR. The mean binocular near uncorrected visual acuity (NUCVA) increased in the hyperopic group from 0.86 ± 0.62 logRAD to 0.24 ± 0.23 logRAD, and in the emmetropic group from 0.48 ± 0.14 logRAD to 0.18 ± 0.11 logRAD. The myopic presbyopes showed a decrease of the mean binocular NUCVA from 0.04 ± 0.19 logRAD to 0.12 ± 0.18 logRAD. The mean postoperative spherical equivalent for distance refraction was -0.13 ± 0.61 D for the hyperopic presbyopia, -0.43 ± 0.35 D for the emmetropic presbyopia, and -0.68 ± 0.42 D for the myopic presbyopia group, whereas the software took aim at -0.50 D in all groups.

Conclusions: In presbyopic patients without symptomatic cataracts, but refractive errors, PresbyMAX® will decrease the presbyopic symptoms and correct far distance refraction in the same treatment, offering spectacle-free vision in daily life in most of the treated patients. Further investigation is necessary to evaluate the overall benefit of this procedure.

MeSH terms

  • Adult
  • Aged
  • Contrast Sensitivity / physiology
  • Cornea / physiopathology
  • Cornea / surgery*
  • Corneal Topography
  • Corneal Wavefront Aberration / physiopathology
  • Eyeglasses
  • Female
  • Humans
  • Hyperopia / physiopathology
  • Hyperopia / surgery*
  • Keratomileusis, Laser In Situ / methods*
  • Lasers, Excimer / therapeutic use*
  • Male
  • Middle Aged
  • Myopia / physiopathology
  • Myopia / surgery*
  • Presbyopia / physiopathology
  • Presbyopia / surgery*
  • Surgical Flaps
  • Treatment Outcome
  • Vision, Binocular / physiology
  • Visual Acuity / physiology