Treatment of moderate-to-high hyperopia with the WaveLight Allegretto 400 and EX500 excimer laser systems

Abstract

PurposeTo evaluate the efficacy of treating patients with +3.00 diopters (D) to +6.00 D of hyperopia via laser-assisted in situ keratomileusis (LASIK) with the WaveLight Allegretto 400 and EX500 excimer laser systems.SettingPrivate clinical ophthalmology practice.Patients and methodsThis was a retrospective study of patients undergoing LASIK treatments of +3.00 to +6.00 D on two different WaveLight laser systems: 163 eyes on the 400 (Hertz) Hz system and 54 eyes on the 500 Hz system. The duration of follow-up was 6 months postoperation. Data were evaluated for uncorrected distance visual acuity, corrected distance visual acuity (CDVA), spherical equivalents (SEQs), and changes in these parameters (eg, loss of vision, regression over time).ResultsTreatment with both lasers was safe and effective, with loss of one line of CDVA in four of 162 eyes using the 400 Hz laser system, and none of the 54 eyes with the 500 Hz laser system. Overall, regression ≥0.75 D from goal at 6 months was observed in 11.7% (19/163) of eyes in the 400 Hz laser group and 9.26% (5/54) of eyes in the 500 Hz laser group (regression ≥0.50 D =77.9% [127/163] and 77.8% [42/54], respectively). The mean SEQ regressions for all eyes with moderate hyperopia were 0.10 and 0.18 D for those with high hyperopia.ConclusionsBoth the 400 and 500 Hz excimer laser systems were safe and effective for the LASIK treatment of moderate-to-high hyperopia. The overall rate of regression was low and the amount of regression was relatively small with both systems.

Topographic-guided treatment of hyperopic corrections with a combination of higher order aberration removal with WaveLight^® Contoura and wavefront-optimized hyperopic treatment

“…Treatment of hyperopia with incorporation of HOA removal via topographic-guided ablation has enormous potential. Making a more uniform cornea may well increase overall visual stability, and when combined with the already noted accuracy and stability in our published hyperopia paper, 5 may make hyperopic excimer laser treatment more widespread and trusted among refractive surgeons. We already have seen an increase in quantity and quality of vision documented in the LYRA Protocol manuscripts, 2 – 4 and further refinement of the nomograms may make this procedure more accurate.…”

“…The author undertook a retrospective study and published the results of patients from +3.0 D to +6.0 D of hyperopic correction treated with both the WaveLight ® EX500 and Allegretto 400. 5 That study demonstrated a far lower regression rate compared with past studies on treatment of lower amounts of hyperopia. Many practices report only 10% of their treatments are hyperopic, in our practice, it is about 30%.…”

“…In a past study, we showed that technological changes to the speed of the machine and the shape of the ablation had demonstrated a dramatic positive change in the ability to stably treat even high hyperopia patients. 5 …”

Femtosecond‑LASIK outcomes using the VisuMax®‑MEL® 80 platform for hyperopia and hyperopic astigmatism refractive surgery

“…Although some excimer lasers have been approved for corrections up to +6.0 D ( 1 , 7 ) and current technology using models with wide ablation and high correction speed has greatly improved prognosis ( 1 , 8 ) [large diameter optical areas being more resistant to epithelial hyperplasia that is responsible for real regression ( 1 , 7 )], latent hyperopia is often the reason why refractive surgeons avoid approaching cases of hyperopia and hyperopic astigmatism or limit the surgeries to refractive errors below +3.0 D ( 1 , 8 ). Laser refractive treatment is difficult to choose because ablation of manifest refraction in hyperopia or hyperopic astigmatism may lead postoperatively to recurrence of a degree of hyperopia, falsely interpreted as regression of the laser procedure ( 1 , 6 , 7 ), while ablation of cycloplegic refraction may lead to myopic refraction in the immediate postoperative period, causing an unsatisfactory UDVA ( 1 ). In order to compensate in part for the latent hyperopia, Kanellopoulos proposed a nomogram that involves full treatment in the case of the cylinder and the ablation of the manifest refraction sphere with an addition of +0.25 D for the dominant eye and up to +0.75 D for the non-dominant eye ( 1 , 9 ).…”

Treatment of high myopia/myopic astigmatism with a combination of WaveLight Contoura with LYRA protocol and wavefront-optimized treatment

“… 2 As spherical aberration was reduced via several laser modalities, such as wavefront guided, wavefront optimized (WFO), and aspheric ablation, outcomes improved dramatically, 3 but the prejudice among surgeons on performing high myopic excimer laser corrections such as −9.00 D and higher remained. 4 …”