Abstract:Objective: To evaluate visual quality, safety and efficacy after optimized monovision Q-value-customized femtosecond laser-assisted in situ keratomileusis (Custom-Q FS-LASIK) for moderate myopia and myopia astigmatism with presbyopia. Methodes: This prospective study enrolled 80 eyes of 40 patients suffering moderate myopia with presbyopia. All patients underwent optimized monovision Custom-Q FS-LASIK. At 12 months post operation, we evaluated full range of visual acuity, uncorrected visual acuity, manifest refraction,total corneal higher order aberrations ( HOAs), Q value, modulation transfer function cut off frequency (MTF cut off), Strehl ratio (SR), objective scatter index (OSI), and near stereoacuity. The impact of surgery on patients' living quality and their satisfaction were evaluated based on National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL) scores at 1-year follow-up. Results: The forty patients included 12 males (30%) and 28 females (70%) with an average age of 46.03 ± 3.60 years (range: 40 to 53 years). One year postoperatively, the uncorrected binocular visual acuity of 20/20 or better at distance, near were all achieved in 97% of patients,The uncorrected binocular visual acuity of 20/30 or better at intermediate were achieved in 89% of patients.The spherical equivalent refraction (SEQ) in dominant eye within ±0.50D was 94%(R2=0.9878).SEQ in non-dominant eyes was -1.30 ± 0.48D, which was uncorrected compared to the expected value of -0.95 ± 0.30 D (the difference was -0.27±0.34D,P < 0.001). while in the nondominant eyes, the Q value became more negative than those before surgery (-0.33 ± 0.24 vs -0.21±0.09, P<0.001).The spherical aberration (SA) and longitudinal spherical aberration (LSA) both decreases significantly in non-dominant eyes (both P < 0.05). Besides, there were no significant changes in OSI, MTF cut off and SR in both dominant and non-dominant eyes (all P > 0.05), while the near stereoacuity was better after surgery while the near stereoacuity was better (p = 0.007). Additionally, the analyses of NEI RQL demonstrated that the satisfaction rate for the surgery was 94%, for visual acuity at distance and near were both 98%. 10.6 % of patients needed to wear low-diopter glasses when driving at night, and 12.7% of patients reported occasional halos under bright lights at night. Conclusions: Optimized monovision Custom-Q FS-LASIK demonstrated satisfactory safety and efficacy for correction of moderate myopia and myopia astigmatism with presbyopia. It achieved favorable subjective and objective visual quality as well as relative high level of patient satisfaction. However, we also observed a undercorrection in non-dominant eyes, indicating the further optimization of nomogram was needed.
