Presbyopia

Correction
for
Middle Aged High
Myopia
 Case of High Myopia Patient

F/47 HOO
1) 2008.9.2/9.4 Phaco with IOL (OU)
2008.4.15. First visit
CC) Far & Near vision disturbance OD) +10D Alcon IQ IOL insertion
OS) +13.5D Alcon IQ IOL
MR OD : -12.0sph
OS : -7.25sph = -1.5cyl A135 POD #2M MR(OD) -2.25D sph.
Add : +1.5D (OU) UCVA(OD) Far : 0.3
Near : J1 (0.8)
UCVA Far : FC/0.04 BCVA(OD) Far : 0.8
Near : J16/J16 Near : J1+(1.0)
BCVA Far : 0.5/0.7 2) 2008.11.19 Keralaser (OD)
Near : J5(0.333)/J7(0.287)
POD #1D UCVA(OD) Far : 0.8
Near : J1+ (1.0)
Surgical Plan (OU):
1st Step : Cataract operation

2nd Step : Keralaser presbyopia

correction
 Kera Pesbyopia #1D

Phaco+IOL #2M
Short Term Result of
Presbyopia
Correction
Using Kera Laser
Method & Patients
Prospective clinical trial

▪ Period : 03. 2008 ~ 10. 2008

by Park Woo Chan

▪ Group : 40 Eyes
* Myopic Presbyopia (24 eyes)
(PRK:LASIK = 13:11)
* Hyperopic Presbyopia (16 eyes)
(PRK:LASIK = 0:16)
 Follow up:
1 주일 , 2 주일 ,1 개월 , 2 개월 , 3 개월 , 6
개월
Pre& postoperative examinations
• UCVA (Far & Near)
• BCVA (Far & Near)
• AR, MR, Wavefront refraction
• Slit lamp examination
• Keratometer
• Topography
• Pachymeter
• Pupillometer
• Specular microscopy
• BUT, Schirmer test
• Corneal sense by Cochet-Bonnet aesthesiometer
• IOP, VF, OCT
• Contrast sensitivity (CSV-1000)
mesopic, photopic & halogen
• Wavefront Aberration Analysis (LadarWave)
• Fundus examination
 Method
• 수술은 한 명의 술자 (Park Woo Chan) 에 의해 시행
• PRK 군은 모두 띠모양 양막과 T-lens 사용함 .
• LASIK 군은 Hansatome® 을 이용해 160 ㎛의 각막절편
•
• 통계 분석은 SPSS(release 12.0K) 의 T-test 와 , 상관관계
를 알아보기 위해 피어슨 상관계수 (Pearson correlation
coefficient) 를 이용하였고 , P<0.05 를 통계학적으로 유의하
다 하였다 .
 Demography

Eyes Male/Femal Age Mean F/U period

e (month)
(eyes)
Myopic Presbyopia 24 3/21 51.25 ± 3.18 4.17 ± 1.74
Hyperopic 16 6/10 53.88 ± 4.86 2.50 ± 1.71
Presbyopia
Total 40 9/31 52.30 ± 4.09 3.50 ± 1.89
(range: 1~7 month)
 Biometry
Myopic Hyperopic Total
Presbyopia Presbyopia (40 eyes)
(24 eyes) (16 eyes)
Pupil Size (mm) 6.50 ± 0.79 5.53 ± 0.64 6.11 ± 0.87
Central CT (um) 574.67 ± 24.10 552.56 ± 29.10 565.83 ± 28.08
Endothelial CD 2350.71 ± 414.88 2467.38 ± 347.01 2397.38 ±
388.81
IOP (mmHg) 14.46 ± 2.47 16.13 ± 2.78 15.13 ± 2.69
Schirmer Test 6.13 ± 5.19 8.00 ± 6.25 6.88 ± 5.63
(mm)
BUT (sec) 5.59 ± 2.94 6.29 ± 2.97 5.86 ± 2.93
Corneal Sense 5.44 ± 0.53 5.50 ± 0.58 5.42 ± 0.52
(cm)
Preop. SE (D) -2.86 ± 1.87 0.84 ± 0.50
(-0.125 ~ -6.125) (0 ~ +1.75)
CT = Corneal Thickness, CD = Cell Density, SE = spherical
equivalent
Results
PRK vs LASIK in Myopic Presbyopia

J1

J1+
J1
J3
J2
J3 J5

J5 J10
J10
J16
PRK vs LASIK in Myopic Presbyopia

(D)
 Change of Visual Acuity
근시성 노안 (Far) 근시성 노안 (Near)
1. 2 1. 2

1. 0
J1+
1. 0
J1
0. 8 0. 8
J2
0. 6 0. 6 J3
0. 4
J5
0. 4
BCVA(F) J10
BCVA(N)
0. 2 0. 2
UCVA(F) J16
UCVA(N)
0. 0 0. 0
술전 1주 2주 1개월 2개월 3개월 6개월 술전 1주 2주 1개월 2개월 3개월 6개월

원 시 성 노안 (Far) 원 시성 노 안 (Near)
1. 2 1. 2
J1+
1. 0 1. 0
J1
0. 8 0. 8
J2
0. 6 0. 6 J3
0. 4 0. 4 J5
BCVA(F) BCVA(N)J10
0. 2 0. 2 J16
UCVA(F) UCVA(N)
0. 0 0. 0
술전 1주 2주 1개월 2개월 3개월 술전 1주 2주 1개월 2개월 3개월
 Gain & Loss of Visual Acuity

Eye

POD : 3mo
 Cumulative UCVA
(%) 근시 노안 (Far) (%) 근시 노안 (Near)

J1+ J1+~J2 J2~J3 J3

(%) 원시 노안 (Far) (%) 원시 노안 (Near)

J1+ J1+~J2 J2~J3 J3

Change of Spherical Equivalent
근시 노안
(D)
0. 5
0. 0
- 0. 5
- 1. 0
- 1. 5
- 2. 0
- 2. 5
- 3. 0
- 3. 5
술전 1주 2주 1개월 2개월 3개월 6개월

원시 노안
(D)
1. 0
0. 8
0. 6
0. 4
0. 2
0. 0
- 0. 2
- 0. 4
- 0. 6
- 0. 8
술전 1주 2주 1개월 2개월 3개월
 Achieved vs Attempt Correction

(D) (D)

(D) (D)

Pearson 상관계수 : 0.890, Pearson 상관계수 : 0.493,

P=0.000 P=0.104
≤ ± 0.5 D : 55.00% (n=20) ≤ ± 0.5 D : 83.33% (n=12)
≤ ± 1.0 D : 57.45% ≤ ± 1.0 D : 91.67%
POD : 3mo
 Change of High Order Aberration
(6 mm OZ)

(um) (um)
 Change of Contrast Sensitivity

Photopic Mesopi Haloge

c n
3 cpd 6 cpd 12 cpd 18 cpd 3 cpd 6 cpd 12 cpd 18 cpd 3 cpd 6 cpd 12 cpd 18 cpd
근시 술전 5.04 4.79 4.67 4.46 5.00 4.79 4.21 4.13 4.92 4.92 4.04 4.54
노안 1 개월 4.94 4.39 3.78 4.00 4.78 4.72 3.94 4.06 4.61 4.33 3.89 4.11
2 개월 5.31 5.15 4.92 4.54 5.23 5.15 5.00 4.46 4.92 4.69 4.85 5.00
3 개월 5.00 4.82 5.00 4.18 5.18 4.82 4.64 4.27 5.09 4.91 4.64 4.00
6 개월 5.50 5.00 5.00 4.75 5.63 4.88 5.13 4.75 5.50 4.88 4.75 4.63

3 cpd 6 cpd 12 cpd 18 cpd 3 cpd 6 cpd 12 cpd 18 cpd 3 cpd 6 cpd 12 cpd 18 cpd
원시 술전 5.00 5.19 5.25 5.13 5.13 5.06 4.75 5.00 5.00 4.94 4.75 5.13
노안 1 개월 5.10 5.30 4.70 4.90 5.00 5.20 4.60 4.90 5.10 4.70 4.30 5.00
2 개월 5.00 5.50 4.50 5.50 4.00 5.50 4.75 4.25 5.00 5.25 4.25 5.00
3 개월 5.00 5.50 5.00 5.50 5.00 5.00 5.00 5.50 5.00 5.00 5.00 5.00
6

5 근시 노안
4

1
Photopic
0
3 cpd 6 cpd 12 cpd 18 cpd

1
Mesopic
0
3 cpd 6 cpd 12 cpd 18 cpd

1 Halogen Glare
0
3 cpd 6 cpd 12 cpd 18 cpd
6

5 원시 노안
4

1
Photopic
0
3 cpd 6 cpd 12 cpd 18 cpd

1
Mesopic
0
3 cpd 6 cpd 12 cpd 18 cpd

1
Halogen Glare
0
3 cpd 6 cpd 12 cpd 18 cpd
Change of other factors
 Change of other factors
PRK

LASIK