1. 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

2. 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.

3. 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

4. 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

5. 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

6. True K Values in a Surgical Treatment Plan

7. Increased K Values Create a Hyperprolate Ablation

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

9. Post-Op Distance BCVA 1 Month

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

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

12. 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