Multifocal LASIK for Correction of Presbyopia with a Variable Spot Scanning Excimer Laser Jay Fiore MD, Eric Donnenfeld MD, Hank Perry MD, Dana Morschauser OD Ophthalmic Consultants of Long Island TLC Laser Eye Center Dr. Donnenfeld is a consultant for Allergan , Alcon, AMO, Aquesys, Advanced Vision Research, Bausch & Lomb, CRST, Eyemaginations, Glaukos, Inspire, Lacripen, Odyssey, Pfizer, QLT, Sirion, TLC Laser Centers, TrueVision, and Wavetec Dr. Perry is a consultnt for Allergan, Inspire

Multifocal Corneal Ablation Multifocal corneal ablation is not currently available in the United States although it has been investigated in other parts of the world. The purpose of this study is to evaluate a novel off label technique for performing a multifocal excimer laser corneal ablation and to evaluate efficacy and safety.

Hyper-Prolate Aspheric Corneas Create Increased Depth of Field The combination of mono-vision (central rays are focused in front of the retina) and a hyper-prolate shape of the cornea (peripheral rays are focused behind the central rays) creates a larger depth of field. Courtesy Theo Seiler

CustomVue Keratometry Cosine Effect – Can be modified to produce a prolate peripheral ablation during excimer laser photoablation Steeper corneas receive additional pulses in the periphery

Methodology to Increase Negative Spherical Aberration and Depth of Field Treat Dominant eye with traditional custom ablation zone and keratometry Treat Non-Dominant eye (Prolate eye) with custom ablation and: Reduce optical zone/ablation zone from 6.0/8.0 mm to 5.5/7.5 mm Increase programmed keratometry by 15 diopters Methods-22 patients with a mean age of 49.2 (range 43-55) and a mean myopia of – 4.35 D underwent bilateral LASIK with the non-dominant eye receiving a hyperprolate ablation. Patients were followed at 1 week and 1 month

True K Values in a Surgical Treatment Plan

Increased K Values Create a Hyperprolate Ablation

Post-Op Spherical Aberration 1 month microns P=.820

Post-Op Distance BCVA 1 Month

Best Corrected Distance Near 0.33 cm at 1 Month P=.044 P=.016 All patients under age 47

Best Corrected Distance Intermediate 0.5 cm at 1 Month P=.007 P=.018

Conclusions: Hyperprolate Peripheral Ablation 2-3 line increase in near and intermediate vision Minimal loss of distance UCVA or BCVA No need to doublecard No risk of decentered ablation Long term evaluation with contrast sensitivity is required