Learn more: http://www.sfe.ru/information/ophthalmology-news/ASCRS_2015_111.html

1. One-Year Outcome of Presbyopia
Correction in Myopic and Hyperopic
Ametropia With Monovision
Approach in Surface Ablation
Prof. Erika N. Eskina, MD,
Ophthalmological Department
of National medical-surgical center
Institute of postgraduate medical education
Ministry of Health RF
Laser surgery clinic SPHERE, Moscow, Russia
FINANCIAL DISCLOSER: I got a travel expenses reimbursement from SCHWIND
Eye Tech Co,
The investigation has been performed without any side financial support
ASCRS, 2015

2. • Purpose
To investigate the outcomes among presbyopic patients who
underwent µ-monovision bi-aspheric multifocal PRK treatments.
• Methods
Ongoing clinical study performed on 22 consecutive presbyopic
patients (44 eyes), 10 myopic and 12 hyperopic patients in age from 40
to 59 with SEQ from -6.50D to +4.25D and astigmatism up to 2D with
surgical add from 1.75D to 2.25D.
All presbyopic treatments were planned with Custom Ablation
Manager software and ablations were performed using the SCHWIND
AMARIS laser system (both SCHWIND eye-tech-solutions).
Uncorrected distance and near visual acuities, refractive outcome,
safety, corneal spherical aberration were recorded up to 12 months of
follow up.

3. SCHWIND PRESBYMAX Μ-MONOVISION
∆ 0.75D
-0.125D -0.875D-1.0D -1.75D
With µ-Monovision
PresbyMAX®
Distance Eye („dominant“) Near Eye („non-dominant“)
The presbyopia correcting EFFECT in SCHWIND PresbyMAX® is based on:
•BI-ASPHERIC MULTIFOCAL PROFILE
•CREATING THE NEGATIVE SPHERICAL ABERRATION
•FORMING µ-MONOVISION (ANISOMETROPIA)
•PUPIL MOBILITY DURING THE ACCOMODATION

4. Results UDVA
Cumulative postoperative uncorrected distance VA (20/x) separated in 10 myopic and
12 hyperopic patients
80% of myopic and 92% of hyperopic presbyopes with binocular UDVA of 20/25 or
better at 6-12M follow-up

5. Results UNVA
Cumulative postoperative uncorrected near VA separated in 10 myopic and 12
hyperopic patients at 6-12M follow-up
100% of myopic and 83% of hyperopic presbyopes with binocular UNVA of J3/J4 or
better at 6-12M follow-up

6. Results Safety
CDVA pre.op vs. CDVA post.op separated in 20 myopic and 24 hyperopic eyes
at 6-12M follow-up
NO loss of more than one Snellen line (monocular) in both myopic and hyperopic
presby eyes at 6-12M follow-up

7. Results Refractive Outcome
Distribution of spherical equivalent refraction (SEq) in diopter (D) for distance eyes (DE)
and near eyes (NE) at 6-12M follow-up
63% of distance eyes are within ±0.5D from ‘emmetropic’ target
81% of near eyes are within ±0.63D from -0.8D target
Myopic patients

8. Results Refractive Outcome
Distribution of spherical equivalent refraction (SEq) in diopter (D) for distance eyes (DE)
and near eyes (NE) at 6-12M follow-up
85% of distance eyes are within ±0.25D from ‘emmetropic’ target
76% of near eyes are within ±0.25D from -0.8D target
Hyperopic patients

9. Results Spherical aberration
Corneal Spherical Aberration (µm) at 4mm and 6mm analysis diameter separated in 20 myopic
and 24 hyperopic eyes preoperative vs. 6-12M follow-up
MYOPIA
SphAb (4mm) of 0.03±0.06 µm with range -0.05
to +0.18 µm
SphAb (6mm) of 0.34±0.15 µm with range +0.06
to +0.60 µm
HYPEROPIA
SphAb (4mm) of -0.06±0.04 µm with range -0.13
to +0.04 µm
SphAb (6mm) of -0.18±0.22 µm with range -0.55
to +0.41 µm

10. Results Visual Acuity over time
UDVA 0.04 ±0.06 logMAR at 6-month
drops at 12-month
UNVA stable from 3-month
UIVA always one line worse to UDVA
UDVA improves with peak 0.01 ±0.05 logMAR at 12-
month
UNVA decreases over time
UIVAis similar to myopic patient

11. Results Spherical equivalent over time
• No refractive stability of DE after 12-month
• Refractive stability of NE with ~-1.00D after 6-month
• Both distance and near eyes are~0.25D to much
myopic compared to targets
• Refractive stability of DE with ~-0.60D after 1-month
already
• Refractive stability of NE with ~-1.25D after 3-month
• Both distance and near eyes are~0.50D to much
myopic compared to targets

12. Results Summary
Myopic Presbyopes (10 patients – 20 eyes)
• Refractive outcome stabilizes between 1 to
3 month after surgery
• The refractive outcome after 12 month
shows a 0.50D myopic deviation from
intended PresbyMAX target in both
distance and near eyes
• Good UDVA with average 20/25 (0.1
logMAR) after 3 month and more
• Very good UNVA with average J2 (0.1
logRAD) after 3 month and more
• No significant change in spherical
aberration C(4,0) into negative direction
• Very high safety with no loss of Snellen lines
monocularly
Hyperopic Presbyopes (12 patients)
• Refractive outcome changes in distance
eyes until 12 month after surgery but near
eyes stabilizes 6 month after surgery
• The refractive outcome after 12 month
shows a 0.25D deviation from intended
PresbyMAX target in both distance and near
eyes
• Very good UDVA with average 20/20 (0.0
logMAR) after 12 month
• Fair UNVA with average J3 (0.20 logRAD)
after 12 month
• Significant change in spherical aberration
C(4,0) into negative direction
• High safety with no loss of more than 1
Snellen line monocularly

13. Conclusion
• Refractive stability and visual acuity is reached earlier in myopic presbyopes
• High safety of PresbyMAX µ-Monovision PRK procedure
• Change in spherical aberration C(4,0) is more effective in hyperopic presbyopes
• Very good UDVA of 20/20 or better reduces UIVA and UNVA significantly
• Mean outcomes of UDVA of 20/20 to 20/25 and UNVA of J2 to J4 with 6-12
months follow-up
• Hyperopic group needs an even longer follow-up (more than 12 months) for
evaluation of refractive and visual stability

14. Thank you for your kind attention!