Effectiveness of SMILE Combined with Micro-Monovision in Presbyopic Patients: A Pilot Study

Abstract

Binocular summation along all defocus range after a micro-monovision procedure has scarcely been studied. The aim of this pilot study was to evaluate the efficacy of SMILE combined with different levels of micro-monovision in presbyopic patients and to assess the binocular summation effect on contrast sensitivity defocus curves (CSDC) at the 6-month follow-up. Efficacy was assessed on the basis of visual acuity (VA) and stereopsis at far, intermediate, and near distances. Patient-reported outcomes (PROs) and binocular CSDC were also evaluated. Six patients completed the study with a programmed median anisometropia of 0.81 Diopter. The median binocular uncorrected VA was better than 0 logMAR at the three evaluated distances, and stereopsis was not impaired in any patient, achieving a median of ≤119 arcsec at any distance. CSDC increased binocularly after surgery, significantly in the range of -2 to -3 D (p < 0.05). No clinically relevant changes were observed in PROs compared with the preoperative period, and all patients achieved spectacle independence at intermediate/near distance and were likely or very likely to undergo the same surgery. In conclusion, micro-monovision with SMILE could be an effective procedure, with results that might be comparable to other laser correction techniques specifically designed for presbyopia correction.

Keywords: SMILE; binocular summation; efficacy; micro-monovision; presbyopia.

Figure 1

Preoperative best distance corrected versus postoperative uncorrected contrast sensitivity defocus curve. AUCs are the areas under the defocus curves above the 0.3 logCS value for the far (F), intermediate (I), and near (N) distance ranges. Lines represent median values, and vertical bars represent interquartile ranges. Asterisk (*) means p < 0.05.