Photopic pupillometry-guided laser in situ keratomileusis for hyperopic presbyopia

PURPOSE: To evaluate a method of surgically treating presbyopia in hyperopic patients having laser in situ keratomileusis (LASIK) by selecting excimer ablation optical zone diameters based on the photopic pupil. SETTING: Private practice, Beverly Hills, California, USA. METHODS: This prospective analysis comprised 46 patients having hyperopic LASIK for presbyopia. The distance-dominant eye was treated with a standard 6.0 mm optical and 9.0 mm outer zone for full distance correction with no nomogram adjustment from the final preoperative manifest refraction. In the nondominant eye, an algorithm was used to select the optical and blend zone diameters and the optical zone size-dependent programmed amount of correction augmentation. Variables evaluated at the 6-month postoperative visit included preoperative and postoperative manifest refractive spherical equivalent (MRSE), refractive cylinder, and monocular and binocular near and distance uncorrected visual acuities. Patient satisfaction and spectacle dependence were also evaluated. RESULTS: In the near-corrected eye, the mean preoperative and postoperative MRSE was +1.10 diopters (D) +/- 1.20 (SD) and -1.30 +/- 0.56 D, respectively, and the mean refractive cylinder, -0.76 +/- 0.91 D and -0.36 +/- 0.33 D, respectively (P<.05). The mean uncorrected near acuity in the near-corrected eye was J10 preoperatively and J1 postoperatively (P<.0001) and the binocular mean uncorrected near acuity, J10 and J1, respectively (P<.0001). The mean uncorrected logMAR distance acuity in the near-corrected eye was +0.38 +/- 0.31 (20/50) preoperatively and +0.36 +/- 0.25 (20/50) postoperatively (P>.05). The mean binocular uncorrected logMAR distance acuity was +0.30 +/- 0.30 (20/40) and +0.01 +/- 0.08 (20/20) (P<.0001), respectively. The mean overall patient satisfaction score was 8.8 (scale 1 to 10). After LASIK, no patient reported using spectacles full time for near or distance and 15% reported part-time use. CONCLUSION: Photopic pupillometry-guided LASIK may be an effective option when considering surgical treatment of presbyopia in hyperopic patients.