Changes to Corneal Aberrations and Vision After Monovision in Patients With Hyperopia After Using a Customized Aspheric Ablation Profile to Increase Corneal Asphericity (Q-factor)

PURPOSE: To evaluate the visual outcomes and fourth-order Zernike spherical aberrations induced with a customized change in corneal asphericity (ΔQ) correction of presbyopia combined with monovision for hyperopic patients. METHODS: Consecutive hyperopic patients who underwent presbyopic LASIK between September 2013 and July 2014 were included. For the non-dominant eyes, the aspheric ablation profile associated with a myopic refraction was planned using the Custom-Q nomogram (Alcon Laboratories, Inc., Fort Worth, TX). Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), spherical equivalent refraction, ΔQ, and change in corneal spherical aberration coefficient (ΔC 4 0 ) were analyzed. Postoperative data were collected at 1, 3, and 6 months. RESULTS: Sixty-five patients were included. The mean age was 56.5 ± 5.7 years (range: 47 to 70 years). At the 6-month follow-up, the spherical equivalent refraction for non-dominant and dominant eyes was −1.07 ± 0.74 and 0.32 ± 0.55 diopters (D), respectively. The mean binocular UDVA was 0.01 ± 0.04 logMAR (range: −0.12 to 0.30 logMAR); 91% of patients achieved 20/20 or better binocular UDVA and 83% of patients had Jaeger 3 (Parinaud 4) or better binocular UNVA. The ΔQ for non-dominant and dominant eyes was −0.61 ± 0.15 and −0.33 ± 0.25, respectively, for a 6-mm pupil diameter and was significantly higher for non-dominant eyes ( P < .0001). The achieved ΔC 4 0 was −0.49 ± 0.23 µ m for non-dominant eyes (for a theoretical ideal value of −0.40 µ m) and −0.30 ± 0.18 µ m for dominant eyes. For non-dominant eyes, the attempted ΔQ (−0.60) was close to the achieved value (−0.61 ± 0.15). CONCLUSIONS: For hyperopic patients, combining the customized corneal aspheric ablation profile with monovision is safe, effective, and reproducible, inducing intended changes in corneal spherical aberrations. [ J Refract Surg. 2016;32(11):734–741.]