Long-term visual outcomes of laser anterior ciliary excision

Abstract

Purpose: To determine the long-term visual outcomes of six eyes of 3 patients up to 13 years following the Laser Anterior Ciliary Excision (LaserACE) procedure.

Methods: Three male patients of ages 59, 59, and 60 presented for evaluation at Storm Eye Institute, Medical University of South Carolina at 8, 10, and 13 years after the LaserACE procedure for presbyopia, respectively. All 3 patients had a history of laser vision correction (LVC) prior to LaserACE treatment. Visual performance was evaluated using ray-tracing aberrometry, specifically higher-order aberrations, visual Strehl of the optical transfer function (VSOTF), depth of focus (DoF), and effective range of focus (EROF). VSOTF was computed as a function of defocus using a through-focus curve. Subjective DoF was overlaid on the VSOTF through-focus curve to establish the best image quality metric threshold value for correlation between subjective and objective DoF. EROF was determined by measuring the difference in diopters between the near and distance DoF curves, at 50% of VSOTF.

Results: Distance-corrected visual acuity, distance-corrected intermediate visual acuity, and distance-corrected near visual acuity for all patients remained at 20/20 or better up to 13 years postoperatively. EROF averaged 1.56 ± 0.36 (D) for all eyes.

Conclusions and importance: LaserACE provided improvement in near vision functionality in these LVC patients with long-term stability. The LaserACE procedure is not on the visual axis, therefore these patients could still receive correction to their hyperopic regression.

Keywords: Accommodation; Laser anterior ciliary excision; Presbyopia; Visual acuity.

Fig. 1

Laser Anterior Ciliary Excision (LaserACE) surgical technique. Photo A. Quadrant marker; B. Matrix marker; C. Corneal Shield; D. LaserACE micropore ablation; E. Subconjunctival Collagen F. Completed 4 quadrants. Reprinted with permission from Hipsley et al.

Fig. 2

Representative photo of a postoperative Laser Anterior Ciliary Excision patient eye under a slit lamp.

Fig. 3

Representative example of image quality metrics at near, distance, and the difference.

Fig. 4

Determining objective accommodation using iTrace aberrometry. Objective accommodation (OA) is measured by determining the spherical equivalent of the difference between distance and near refraction. Examples shown for A. non-presbyopic eye (OA = 2.63 D); B. presbyopic eye (OA = 0.32 D).

Fig. 5

Effective range of focus. Visual Strehl ratio based upon the optical transfer function is computed as a function of defocus using a through-focus curve. Patient eye (OD): A. 101, B. 102, C. 103.

Fig. 6

Effective range of focus. Visual Strehl ratio based upon the optical transfer function is computed as a function of defocus using a through-focus curve. Patient eye (OS): A. 101, B. 102, C. 103.

Fig. 7

Refractive and wavefront difference maps at distance and near using ray-tracing. Maps show accommodation and pseudoaccommodation components. Patient eye (OD): 1 A. 101, B. 102, C. 103.

Fig. 8

Refractive and wavefront difference maps at distance and near using ray-tracing. Maps show accommodation and pseudoaccommodation components. Patient eye (OS): A. 101, B. 102, C. 103.

Fig. 9

Patient averages of depth of focus, effective range of focus, visual Strehl ratio based on the optical transfer function, higher order aberrations: OD (black), OS (white), OU (gray).