Eyeworld

EW REFRACTIVE SURGERY 50 August 2015 For those eligible for monovi- sion LASIK correction of presbyopia, however, the procedure has proved quite effective, Dr. Pallikaris said. He thinks that upward of 70% of post-cataract patients undergo the procedure, with excellent visual out- comes. Although he favors mono- vision in younger presbyopes, Dr. Pallikaris noted that success with the procedure is not dependent upon patient age. He said that recent studies have found success rates for the procedure ranging from 70% to 98%, with patients between the ages of 35 and 55 generally found to have good blur suppression, post-treat- ment anisometropia of less than 2.5 D, and preserved stereoacuity. It is thought that patients respond well to the procedure because it offers improved binocular adaptation with constant optical correction, with less aniseikonia than with spectacles. 1,2 "The age of the patient has nothing to do with [outcomes]," he said. "Regardless of patient age, the final target is zero correction in the dominant eye and a slight overcor- rection in the non-dominant eye." Possible drawbacks To date, according to Dr. Pallikaris, the only known drawbacks associ- ated with monovision LASIK are a small reduction in contrast sensitiv- ity and depth perception in some patients. Other side effects associat- ed with the procedure include blur or fog in distance or near vision, glare and halos (particularly at night), reduced vision at night, and transient diplopia caused by tempo- rary strabismus; however, these side effects typically resolve over time as patients adapt to their new vision. Patients with prior experience with monovision through contact lens wear tend to adapt their vision following monovision LASIK much quicker. Some studies have found that as many as 90% of presbyopes undergoing the procedure have uncorrected distance and near visual acuity levels that allow them to remain contact lens- and/or specta- cle-free. 3,4 by Brian P. Dunleavy EyeWorld Contributing Writer Expert discusses use of monovision in presbyopic patients M onovision with LASIK is the "preferred pro- cedure" for renowned surgeon and expert Ioannis G. Pallikaris, MD, professor of ophthalmology, University of Crete, Greece, and director of the eye clinic, University Hospital of Heraklion. Dr. Pallikaris, who spoke to EyeWorld in a video interview at the 2014 American Academy of Oph- thalmology meeting in Chicago, discussed his preferred technique in presbyopic patients: monovision. In the video interview, he said that he now favors the technique for younger presbyopes, generally those between 45 and 60 years of age, but only in those candidates who are indicated. "Monovision is the technique that I'm using mostly today for early presbyopes," he said. "One reason is those presbyopes are not candidates for cataract surgery with the laser. And in this case, monovision with LASIK is the preferred procedure." However, patient selection is vital in this patient population, he said. "The candidates have to be eval- uated very carefully because they're not always accepting of this type of correction," Dr. Pallikaris said. Patient evaluation After careful evaluation, as many as two-thirds of pre-cataract presbyopes can be treated with monovision LASIK successfully. Patient evalua- tions for the procedure, he empha- sized, must include an assessment of refraction in full dilation so that the degree of hyperopia can be accurate- ly measured. Research has shown that many of those diagnosed in their late 30s with presbyopia are ac- tually hyperopic; monovision LASIK correction in these patients might have an adverse effect on visual outcomes. Monovision in LASIK patients continued on page 52

• Cover