eMedicine Specialties > Ophthalmology > Refractive Disorders

Hyperopia, LASIK: Follow-up

Author: Arun C Gulani, MD, Director, Gulani Vision Institute
Contributor Information and Disclosures

Updated: Nov 24, 2008

Outcome and Prognosis

The results of hyperopic LASIK have been encouraging and relatively stable at 6 months postoperatively. Refractive stability occurred from 1-2 weeks postoperatively and remained stable at 6 months. The results with uncorrected visual acuity were similar, with vision stabilizing from 1-2 weeks postoperative.

In this study, patients who underwent LASIK had a mean preoperative sphere of +2.6 D. Ninety percent of the eyes attained 20/40 or better postoperative unaided vision, while 50% of eyes were 20/20. These results correlated with a hyperopic LASIK report of a similar preoperative hyperopic category of patients in which 95% of eyes achieved 20/40 or better unaided vision. No lines of best-corrected visual acuity were lost.

In this study series, no significant haze, decentrations, central islands, irregular astigmatism, or interface deposits/inflammation were observed. Epithelial ingrowth did occur in 3 cases. This epithelial ingrowth was mild and restricted to the periphery. In these cases, the corneal flaps were uniform in thickness and well aligned as were the corneal topographies. At the 8-month postoperative gate, one of these eyes underwent flap lifting and interface cleansing. A specially designed flap lifter was used to elevate the flap without eroding the surgically steepened stromal mound.

See related CME at Corneal Ectasia Following LASIK Surgery.

Future and Controversies

The surgical correction of hyperopia remains a challenge and a worthy pursuit in the field of refractive surgery. The basic principle of corneal surgery for hyperopic correction remains in carving a lens shape that is steeper in the center by graded removal of tissue in the periphery.

The possibility of regression will continue to be a concern in such a surgical profile because of the natural or sometimes hyperplastic healing response of the cornea to fill in this ablated step between the treated and untreated zones, thereby not only resulting in loss of effect over time but also inducing an astigmatic error in case of uneven fill-ins. With the surge of technological advances and the availability of smoother ablation systems, along with microkeratomes aiding larger corneal flaps, these concerns may be addressed. This author has no experience with piggyback intraocular lenses.

In the author's experience, LASIK is presently the treatment of choice for this grade of hyperopia. A welcome surprise in the results was a simultaneous improvement in near vision associated with this hyperopic LASIK technique. An investigation occurred to check if cylinder was being induced, thereby aiding the patient's presbyopia; the investigation revealed no significant induction of cylinder. Therefore, this improvement in presbyopia could be a direct result of the corneal multifocality that results from this work. Such postablation corneal multifocality has been previously observed and reported.

This improvement is a welcome advantage in the presbyopic age group and has remained stable at the 6-month postoperative gate. Hyperopic LASIK using these intra-ablative contact lenses has been successful at the 6-month postoperative period with no loss of best-corrected visual acuity. The future of refractive surgery seems promising as a transition is predicted from cornea-focused refractive surgery with its inherent variabilities toward intraocular surgery using multifocal lenses and phakic implants.

At this time, the important issue is that hyperopia is finally receiving its due attention.

 


More on Hyperopia, LASIK

Overview: Hyperopia, LASIK
Treatment: Hyperopia, LASIK
Follow-up: Hyperopia, LASIK
Multimedia: Hyperopia, LASIK
References
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References

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Further Reading

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Keywords

hyperopic LASIK, hyperopia, farsightedness, laser refractive surgery, distance vision, excimer laser, laser in situ keratomileusis

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Contributor Information and Disclosures

Author

Arun C Gulani, MD, Director, Gulani Vision Institute
Arun C Gulani, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Daniel S Durrie, MD, Director, Department of Ophthalmology, Division of Refractive Surgery, University of Kansas Medical Center
Daniel S Durrie, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Louis E Probst, MD, Medical Director of Refractive Surgery, Chicago, Madison, Milwaukee, and Windsor Centers, TLC the Laser Eye Centers
Louis E Probst, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and International Society of Refractive Surgery
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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