Laser in situ Keratomileusis for Spherical Hyperopia and Hyperopic Astigmatism Using the NIDEK EC-5000 Excimer Laser

Abstract

<h4>PURPOSE</h4><p>To assess the efficacy, predictability, and safety of LASIK for the surgical correction of low to moderate hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser.</p> <h4>METHODS</h4><p>In a multicenter United States Food and Drug Administration (FDA) regulated study of LASIK, 7 centers enrolled 293 eyes with manifest refraction sphere that ranged from +0.50 to +6.00 diopters (D) with or without astigmatism up to 3.00 D. The intended outcome was plano in all eyes. Patients were treated bilaterally. One year postoperative outcomes are reported. </p> <h4>RESULTS</h4><p>The mean spherical equivalent refraction (MRSE) for all eyes changed from +2.61±1.19 D (range: +0.50 to +6.63 D) preoperatively to +0.35±0.54 D (range: -1.63 to +2.00 D) 1 year postoperatively. Overall, 61% (170/279) of eyes achieved distance uncorrected visual acuity (UCVA) of 20/20 or better, 82% (228/279) of eyes saw 20/25 or better, and 99% (277/279) of eyes saw 20/40 or better. Refractive accuracy was demonstrated as 63.1% (176/279) of eyes achieved a MRSE within ±0.50 D and 90.3% (252/279) of eyes within ±1.00 D. Less than 2% (4/279) of eyes lost 2 lines of distance best spectacle-corrected visual acuity. Stability of refraction was demonstrated by 6 months, with a mean hyperopic shift of <0.03 D from 3 to 6 months. </p> <h4>CONCLUSIONS</h4><p>The NIDEK EC-5000 corrected hyperopia and hyperopic astigmatism with UCVA, refractive accuracy, 1-year stability, and safety that surpassed all FDA criteria. [<cite>J Refract Surg.</cite> 2008;24:123-136.]</p> <h4>ABOUT THE AUTHORS</h4> <p>From InView, Atlanta, Ga (Waring); Clinical Research Consultants Inc, Cincinnati, Ohio (Fant); Sound Eye and Laser, Seattle, Wash (Phillips); Fischer Laser Eye Center, Willmar, Minn (Fischer); Liberty Laser Eye Center, Vienna, Va (Tanchel); Southern Eye Associates, Memphis, Tenn (Schanzer); the Department of Ophthalmology, Loma Linda University, Loma Linda, Calif (Narvaez); and CODET/Aris Vision Institute, Tijuana, BC, Mexico (Chayet).</p> <p>Dr Waring is a consultant for NIDEK, AMO, Acufocus, Calhoun Vision, and SCHWIND. Dr Chayet is a consultant for NIDEK and Calhoun Vision. Dr Fant is a consultant for NIDEK and has a financial interest in Clinical Research Consultants Inc. The remaining authors have no financial interest in the materials presented herein.</p> <p>Correspondence: George O. Waring III, MD, InView, 301 Perimeter Center North, Ste 600, Atlanta, GA 30346. Tel: 678.222.5102; Fax: 404.250.9006; E-mail: <a href="mailto:drgeorge@georgewaring.com">drgeorge@georgewaring.com</a></p> <p>Received: June 25, 2007</p> <p>Accepted: December 4, 2007</p>

Long-Term Followup of LaserIn SituKeratomileusis for Hyperopia Using a 213 nm Wavelength Solid-State Laser

“…MRSE at the last follow-up visit of 55.88% and 85.30% of the study eyes was within ±0.50 D and ±1.0 D of the intended MRSE, respectively, which reflects the refractive accuracy of hyperopic LASIK using the 213 nm laser. This is in accordance with other studies using the conventional excimer laser [2, 4, 5, 7, 14, 15, 18–21]. The mean difference between the preoperative and postoperative K values of 2.71 D, which is close to the attempted hyperopic correction of 3.22 D, further mirrors its accuracy in terms of ablation profile.…”

“…These levels coincide with reports by Zadok et al [2] (≥20/20, 29.3%; ≥20/40, 85.7%), Desai et al [5] (≥20/20, 34.1%; ≥20/40, 87.8%), and Göker et al [19] (≥20/20, 14.81%; ≥20/40, 66.66%). However, levels reported by Cobo-Soriano et al [7] (≥20/20, 46.8%; ≥20/40, 93%), Waring et al [15] (≥20/20, 70.1%; ≥20/40, 99.3%), and Nepomuceno et al [20] (≥20/20, 44.4%; ≥20/40, 88.9%) were better than those achieved in our study. The low proportion of eyes having a UCVA of 20/20 or better at the end of followup was attributed to the relatively significant number of eyes having preoperative astigmatism of ≥0.50 D (0.5 D: 14.71%, 0.75 D: 2.94%, 1.0 D: 17.65%, 1.5 D: 14.71%, 2.25 D 2.94%, 3.0 D 8.82%).…”

“…Other published works reported refractive stability after the first month [14], at 3 months [17], and at 6 months [15, 22]. Regression was also noted at various postoperative periods, starting at 1 month [14], 3 months [15], and 1 year [5, 16]. In the Beaver Dam Eye Study [23], the mean hyperopic shift over a 5-year period was +0.12 D in a population consisting of individuals aged 43–84 years.…”

Laser-assisted subepithelial keratectomy for bilateral hyperopia and hyperopic anisometropic amblyopia in children

“…In addition, some studies of adults having laser treatment for hyperopia 19,52 report irregular astigmatism postoperatively, which can result in unacceptable vision. Nevertheless, many studies 16,18,48,50,51 report achievement of the targeted refraction and longterm stability (usually after LASIK), especially in cases of moderate hyperopia (% C 5.00 D). Autrata and Rehurek 9 treated hyperopia with LASEK and report good visual and refractive results.…”

Refractive regression after laser in situ keratomileusis

“…Nevertheless, we could assume that the rates of retreatment probably reflect those subjects who have an enhancement due to clinically significant regression. The incidence of refractive regression following hyperopic LASIK is estimated to be approximately 30% during the first postoperative year . The incidence following myopic LASIK has been reported to vary from 5.5% to 27.7% .…”