Skip to main content

Role of preoperative cycloplegic refraction in LASIK treatment of hyperopia

Abstract

Background

Previous studies have suggested that, to improve refractive predictability in hyperopic LASIK treatments, preoperative cycloplegic or manifest refraction, or a combination of both, could be used in the laser nomogram. We set out to investigate (1) the prevalence of a high difference between manifest and cycloplegic spherical equivalent in hyperopic eyes preoperatively, and (2) the related predictability of postoperative keratometry.

Methods

Retrospective cross-sectional data analysis of consecutive treated 186 eyes from 186 consecutive hyperopic patients (mean age 42 [±12] years) were analyzed. Excimer ablation for all eyes was performed using a mechanical microkeratome (SBK, Moria, France) and an Allegretto excimer laser platform. Two groups were defined according to the difference between manifest and cycloplegic spherical equivalent which was defined as ≥1.00 diopter (D); the data was analyzed according to refractive outcome in terms of refractive predictability, efficacy, and safety.

Results

In 24 eyes (13 %), a preoperative difference of ≥1.00D between manifest spherical equivalent and cycloplegic spherical equivalent (= MCD) occurred. With increasing preoperative MCD, the postoperative achieved spherical equivalent showed hyperopic regression after 3 months. There was no statistically significant effect of age (accommodation) or optical zone size on the achieved spherical equivalent.

Conclusions

A difference of ≥1.00D occurs in about 13 % of hyperopia cases. We suggest that hyperopic correction should be based on the manifest spherical equivalent in eyes with preoperative MCD <1.00D. If the preoperative MCD is ≥1.00D, treatment may produce manifest undercorrection, and therefore we advise that the patient should be warrned about lower predictability, and suggest basing conclusions on the arithmetic mean calculated from the preoperative manifest and cycloplegic spheres.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

References

  1. Gatinel D, Malet J, Hoang-Xuan T, Azar DT (2004) Corneal asphericity change after excimer laser hyperopic surgery: theoretical effects on corneal profiles and corresponding Zernike expansions. Invest Ophthalmol Vis Sci 45:1349–1359

    Article  PubMed  Google Scholar 

  2. Huang D, Tang M, Shekhar R (2003) Mathematical model of corneal surface smoothing after laser refractive surgery. Am J Ophthalmol 135:267–278

    Article  PubMed  Google Scholar 

  3. Roberts C (2002) Biomechanics of the cornea and wavefront-guided laser refractive surgery. J Refract Surg 18:589–592

    Google Scholar 

  4. Alió J, Galal A, Ayala MJ, Artola A (2006) Hyperopic LASIK with Esiris/Schwind technology. J Refract Surg 22:772–781

    PubMed  Google Scholar 

  5. Llovet F, Galal A, Benitez-del-Castillo JM, Ortega J, Martin C, Baviera J (2009) One-year results of excimer laser in situ keratomileusis for hyperopia. J Cataract Refract Surg 35:1156–1165

    Article  PubMed  Google Scholar 

  6. Waring GO 3rd, Fant B, Stevens G, Phillips S, Fischer J, Tanchel N, Schanzer C, Narvaez J, Chayet A (2008) Laser in situ keratomileusis for spherical hyperopia and hyperopic astigmatism using the NIDEK EC-5000 excimer laser. J Refract Surg 24:123–136

    PubMed  Google Scholar 

  7. Aslanides IM, Mukherjee AN (2013) Adjuvant corneal crosslinking to prevent hyperopic LASIK regression. Clin Ophthalmol 7:637–641

    PubMed  PubMed Central  Google Scholar 

  8. Spadea L, Sabetti L, D’Alessandri L, Balestrazzi E (2006) Photorefractive keratectomy and LASIK for the correction of hyperopia: 2-year follow-up. J Refract Surg 22:131–136

    PubMed  Google Scholar 

  9. Cobo-Soriano R, Llovet F, González-López F, Domingo B, Gómez-Sanz F, Baviera J (2002) Factors that influence outcomes of hyperopic laser in situ keratomileusis. J Cataract Refract Surg 28:1530–1538

    Article  PubMed  Google Scholar 

  10. Zaldivar R, Oscherow S, Bains HS (2005) Five techniques for improving outcomes of hyperopic LASIK. J Refract Surg 21:628–632

    Google Scholar 

  11. Zadok D, Raifkup F, Landau D, Frucht-Pery J (2003) Long-term evaluation of hyperopic laser in situ keratomileusis. J Cataract Refract Surg 29:2181–2188

    Article  PubMed  Google Scholar 

  12. Mrochen M, Donitzky C, Wüllner C, Löffler J (2004) Wavefront-optimized ablation profiles: theoretical background. J Cataract Refract Surg 30:775–785

    Article  PubMed  Google Scholar 

  13. Torricelli AA, Bechara SJ, Wilson SE (2014) Screening of refractive surgery candidates for LASIK and PRK. Cornea 33:1051–1055

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Andreas Frings.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Frings, A., Steinberg, J., Druchkiv, V. et al. Role of preoperative cycloplegic refraction in LASIK treatment of hyperopia. Graefes Arch Clin Exp Ophthalmol 254, 1399–1404 (2016). https://doi.org/10.1007/s00417-016-3308-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-016-3308-z

Keywords

  • Hyperopia
  • LASIK
  • Cycloplegic refraction
  • Manifest refraction
  • Refractive predictability