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P resbyopia

P resbyopia. Abolfazl Kashfi MD Isfahan Medical University. Monovision. Definition : One eye for far full correction, one eye for near (33 c m ) or intermediate (50 cm) correction Patient selection : P atient’s needs: Suitable for those need far and near vision

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P resbyopia

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  1. Presbyopia Abolfazl Kashfi MD Isfahan Medical University

  2. Monovision Definition :One eye for far full correction, one eye for near (33 cm) or intermediate (50 cm) correction Patient selection : Patient’s needs: Suitable for those need far and near vision intermittently. Dominant eye: Dominant eye for far Tolerance: Contact lens trial , strong sighting preference , history of monovision Sex: Females less likely to reject monovision

  3. Monovision Methods: contact lens (since 1958,Westsmith) corneal surgery IOL surgery Usually 1.25-2.00 D at most 3.00 D

  4. Monovision

  5. MonovisionLASIK

  6. MonovisionIOL

  7. PresbyLasik Definition: Making cornea multifocal using excimer laser Normal human cornea is aspheric instead of multifocal Three approaches : 1 Multifocal transitional 2 Peripheral PresbyLasik (Center for distance and midperipheral for near) 3Central PresbyLasik (Hyperpositive center for near and leaving periphery for far)

  8. PresbyLasikMultifocal transitional An intentionally decentered Hyperopic ablation to produce a transitional vertical multifocality ,inducing a significant vertical coma An old technic / Very few publications / Not generally accepted and now abandoned because of doubtful quality of vision

  9. PresbyLasikperipheral presbyLasik Center left for distance and the periphary ablatein a manner which produces a negative aspherisity and a 3 diopter pseudoaccommodation in 4mm pupil VISX, Zeiss, Nidek, Wave light-Allegrato A good DOF but There is an interaction with myopic correction Most studies done in hyperopes 8/10 to 10/10 far vision and J2 for near 6 month neuroadaptation required

  10. PresbyLasikCentral presbyLasik A central hyperpositive area for near and periphery left for far Much prolate cornea much depth of field (KC) Can perform in myopes , hyperopes or emmetropes ,even previous LASIK Minimal tissue ablation 8/10 to 10/10 far vision and J2 for near Pupil dependent Centration is very important ,it is up to induce coma aberration

  11. Femtosecond assisted Intracor First introduced by Ruiz et al in 2009 (83 eyes) followed by Holzer et al in 2009 (25 non dominant eyes) They used TECHNOLAS femtosecond platform to make a series of concentric intrastromal cuts for presbyopic emetrrops/hyperops . They made some intrastromal radial cuts to treat distance vision of presbyopic myops. The produced Hyperprolate cornea will give a better near vision while distance vision is preserved.(negative shift of primery spherical aberrations and positive shift of secondary aberrations)

  12. Video from www.technolaspv.com • INTRACOR1.avi The strongest lamellae of cornea are in the anterior one third of cornea ;during INTRACOR anterior cornea remains intact to avoid uncontrolled ecstasia

  13. Femtosecond assisted Intracor Advantages Painless ,high level of satisfaction Minimally invasive (Epithelium, Bowman, descemet and endothelium are intact)/ minimal risk of infection Short treatment time Significant and rapid near vision improvement Improves depth of focus Minimal changes of CDVA Minimal myopic shift (0.3 D) Minimal endothelial change Stable corneal thickness stable contrast sensitivity Stable total and higher order aberrations

  14. Femtosecond assisted Intracor Disadvantages: Few patients loss 1 to 2 lines of CDVA Symptomatic halo (30% day one , 3% after one year) Not suitable for scotopic pupil > 6.5 mm Many unknowns ? Centering ? Retreatment

  15. Corneal inlaysFlexivue microlens A 3mm hydrophilic lens with 15 microns thickness under a Femtosecond made corneal pocket to correct 2.5 D to 3.5 D presbyopia of non dominant eyes Reported by Pallikaris 2010 One year follow up 100% improvement 92% Nea spectacle free Mean UCNVA after 3 month 20/25 Mean UCDVA after 6 month 20/30 It has CE but not FDA approval

  16. Corneal inlaysKAMRA inlay A 3.8 mm 10 microns thickness implant with a 1.6 mm central hole under a femtosecond made corneal flap to correct vision via pinhole effect Polyvinylidineflouride polymer with 1600 nutritional holes Formerly AcuFocus Reported by Durrie 2010 36 months follow up Mean distance vision 20/20 Mean near vision J1 It has CE but not FDA approval (there is an ongoing 504 patients study in US)

  17. Corneal inlaysKAMRA inlay

  18. Thanks

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