Relationship between Induced Spherical Aberration and Depth of Focus after Hyperopic LASIK in Presbyopic Patients

Objective: To evaluate to what extent the modification of corneal asphericity to induce spherical aberration (SA) can improve the depth of focus and to determine whether preoperative adaptive optics assessment (Voptica SL) can predict an optimal SA value for each patient.
Design: Comparative, prospective clinical trial with paired eye control.
Participants: Patients >45 years old who are hyperopic from +1.00 to +2.50 diopters (D), with eyes suitablefor LASIK surgery.
Intervention: Bilateral hyperopic LASIK surgery using a 200-Hz Allegretto excimer laser. The dominant eye was operated using a conventional profile. The nondominant eye was programmed with an aspheric ablation profile and -0.75 D monovision.
Main Outcome Measures: Primary outcome was the correlation between postoperative SA and depth of focus, defined as the pseudo-accommodation value (PAV ¼ [1/reading distance {m}] e minimum addition [D]). Main secondary outcome was the comparison of depth of focus between patients with an induced SA close to the optimal one (group 1), patients with an induced SA far from the optimal one (group 2), and patients for whom SA induction did not increase the depth of focus (control group).
Results: We included 76 patients. Between preoperative and postoperative assessment, the mean increase of distance-corrected PAV for near vision was +0.25+-0.64 D (P < 0.001) for dominant eyes and -0.63+-0.55 D (P < 0.001) for nondominant eyes. As the level of negative or positive postoperative SA increased, PAV for intermediate and near vision increased. Among the 37 eyes that followed the preoperative adaptive optics assessment, the mean PAV increase at near was significantly higher (P < 0.05) in group 1 (0.93+-0.50 D) than in group 2 (0.46+-0.42 D) and than in the control group (0.35+-0.32 D). The mean optimal SA value determined by the dynamic simulation procedure to optimize the depth of focus was -0.18+-0.13 mm at 4.5 mm.
Conclusions: Aspheric hyperopic LASIK can increase the depth of focus without impairing far vision, but this benefit would be maximal and reproducible if we could define and achieve an optimal SA value determined by preoperative assessment using an adaptive optics instrument.