A Short-Term Clinical Analysis of Q-Value-Guided Micro-Monovision LASIK for Myopic Astigmatism and Presbyopia

Abstract

Objective: To evaluate the safety, effectiveness and predictability of Q-value-guided micro-monovision laser in situ keratomileusis (LASIK) in the treatment of myopia and presbyopia. Methods: A prospective study was performed based on 35 patients (70 eyes) with myopia and presbyopia, who underwent Q-value-guided micro-monovision LASIK in the Affiliated Hospital of Qingdao University from August 2017 to May 2018. At the 3-month postoperative visit, examinations were performed that included binocular and monocular distance and near visual acuity (logMAR), manifest refraction, contrast sensitivity (CS) and stereopsis. In addition, questionnaires of asthenopic symptoms due to near-distance work were also included for all the patients 3 months postoperatively. The data before and after surgery were analyzed using a paired t test. Results: Binocular distance best-corrected visual acuity (BCVA) was 0.01±0.06 before surgery and was -0.04±0.21 at 3 months after surgery. Thus, none of the eyes lost one line after the operation. Uncorrected visual acuity (UCVA) of the dominant eye and the non-dominant eye were -0.04±0.19 and 0.04±0.13, respectively. In all patients, near distance UCVA of the dominant eye was equal to 20/25 or above, and that of the non-dominant eye was 20/20. In addition, the difference between the actually obtained spherical equivalent (SE) and target SE was in the range of ±0.50 D and ±1.00 D for 60 eyes (86%) and 75 eyes (100%), respectively. At 3 months after surgery, CS had a significant improvement of 18.0 c/d spatial frequency under day+peripheral glare (t=-2.504, P=0.017). The spatial frequencies for day 1.5 c/d, 6.0 c/d and 18.0 c/d, day+peripheral glare 6 c/d, night 1.5 c/d and night+peripheral glare 18.0 c/d had significantly decreased compared to that before surgery (P<0.05). All other conditions were restored to preoperative levels. There was no significant difference in stereopsis before and after surgery. No patients suffered from headache, nausea, blurred reading or difficulty with nearsightedness after near-distance work at 3 months postoperatively. All patients (100%) were satisfied with the results of the operation. Conclusions: The Q-value-guided micro-monovision LASIK protocol is a safe, effective and predictable method for the treatment of myopic patients with presbyopia. Patients can obtain better binocular distance, near vision and visual function simultaneously. Key words: myopia; Q value; presbyopia laser in situ keratomileusis; contrast sensitivity; stereopsis