Accommodative changes after SMILE for moderate to high myopia correction

Ke Zheng, Tian Han, Xingtao Zhou, Ke Zheng, Tian Han, Xingtao Zhou

Abstract

Background: To investigate accommodative response and accommodative lag changes after femtosecond laser small incision lenticule extraction (SMILE) for moderate to high myopia correction.

Methods: A total of 32 eyes of 32 patients with no strabismus who underwent SMILE were enrolled in this prospective clinical study. The accommodative response was obtained viewing monocularly with spherical equivalent refractive error corrected, using an open-field autorefractor at different stimulus levels (2.00D, 2.50D, 3.00D, 4.00D and 5.00D) for the right eye before a standard SMILE surgery and at 1-month follow-up after surgery.

Results: The mean age of the patients were 23.34 ± 2.90 years and the mean preoperative manifest refraction spherical equivalent was -5.74 ± 1.98 diopters. Significant differences were detected in both preoperative and postoperative accommodative responses to different stimulus levels (P < 0.001). Multiple linear regression model analysis revealed preoperative manifest refractive spherical equivalent (P = 0.006) and preoperative accommodative lag (P = 0.04) showed a significant impact on postoperative accommodative lag.

Conclusions: This is the first report of accommodative changes after SMILE. Our preliminary results showed that a decrease in postoperative accommodative lag that might be related to the relief of the visual discomfort symptom.

Keywords: Accommodative lag; Accommodative response; Small incision lenticule extraction (SMILE); Visual discomfort symptom.

Figures

Fig. 1
Fig. 1
Preoperative and postoperative accommodative responses to different stimulus levels. A significant difference was detected between the preoperative and postoperative data at different stimulus levels (2.00D: P = 0.022; 2.50D: P = 0.046; 3.00D: P = 0.060; 4.00D: P = 0.030 and 5.00D: P = 0.009)
Fig. 2
Fig. 2
Preoperative and postoperative accommodative lags to different stimulus levels. The accommodative lag for each target stimulus except for 3.00D was significantly smaller in the postoperative group compared with preoperative group. (2.00D; P = 0.022, 2.50D; P = 0.046, 3.00D; P = 0.060, 4.00D; P = 0.030 and 5.00D; P = 0.009)

References

    1. Shah R, Shah S, Sengupta S. Results of small incision lenticule extraction: All-in-one femtosecond laser refractive surgery. J Cataract Refract Surg. 2011;37:127–137. doi: 10.1016/j.jcrs.2010.07.033.
    1. Sekundo W, Kunert KS, Blum M. Small incision corneal refractive surgery using the small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism: results of a 6 month prospective study. Br J Ophthalmol. 2011;95:335–339. doi: 10.1136/bjo.2009.174284.
    1. Zhao Y, Li M, Yao P, Shah R, Knorz MC, Zhou X. Development of the continuous curvilinear lenticulerrhexis technique for small incision lenticule extraction. J Refract Surg. 2015;31:16–21. doi: 10.3928/1081597X-20141218-02.
    1. Ivarsen A, Asp S, Hjortdal J. Safety and complications of more than 1500 small-incision lenticule extraction procedures. Ophthalmology. 2014;121:822–828. doi: 10.1016/j.ophtha.2013.11.006.
    1. Chase C, Tosha C, Borsting E, Ridder WH., 3rd Visual discomfort and objective measures of static accommodation. Optom Vis Sci. 2009;86:883–889. doi: 10.1097/OPX.0b013e3181ae1b7c.
    1. Momeni-Moghaddam H, Goss DA, Sobhani M. Accommodative response under monocular and binocular conditions as a function of phoria in symptomatic and asymptomatic subjects. Clin Exp Optom. 2014;97:36–42. doi: 10.1111/cxo.12074.
    1. Tosha C, Borsting E, Ridder WH, 3rd, Chase C. Accommodation response and visual discomfort. Ophthalmic Physiol Opt. 2009;29:625–633. doi: 10.1111/j.1475-1313.2009.00687.x.
    1. Karimian F, Baradaran-Rafii A, Bagheri A, Eslani M, Bayat H, Aramesh S, Yaseri M, Amin-Shokravi A. Accommodative changes after photorefractive keratectomy in myopic eyes. Optom Vis Sci. 2010;87:833–838. doi: 10.1097/OPX.0b013e3181f6fccc.
    1. Liu LN, Lu F, Wang QM, Xue AQ, Chen SH, Chen HB. Change of accommodative function in phakic eyes with iris-fixated phakic intraocular lens implantation. Zhonghua Yan Ke Za Zhi. 2010;46:621–624.
    1. Fu J, Wang XZ, Wang NL, Wang JH, Zhao SQ. Accommodation perimeters after phakic posterior chamber implantable contact lens implantation. Zhonghua Yan Ke Za Zhi. 2013;49:633–636.
    1. Wick B, Hall P. Relation among accommodative facility, lag, and amplitude in elementary school children. Am J Optom Physiol Opt. 1987;64:593–598. doi: 10.1097/00006324-198708000-00005.
    1. Kalsi M, Heron G, Charman WN. Changes in the static accommodation response with age. Ophthalmic Physiol Opt. 2001;21:77–84. doi: 10.1046/j.1475-1313.2001.00546.x.
    1. Correction of Myopia Evaluation Trial 2 Study Group for the Pediatric Eye Disease Investigator G. Manny RE, Chandler DL, Scheiman MM, Gwiazda JE, Cotter SA, Everett DF, Holmes JM, Hyman LG, Kulp MT, Lyon DW, Marsh-Tootle W, Matta N, Melia BM, Norton TT, Repka MX, Silbert DI, Weissberg EM. Accommodative lag by autorefraction and two dynamic retinoscopy methods. Optom Vis Sci. 2009;86:233–243. doi: 10.1097/OPX.0b013e318197180c.
    1. Momeni-Moghaddam H, McAlinden C, Azimi A, Sobhani M, Skiadaresi E. Comparing accommodative function between the dominant and non-dominant eye. Graefes Arch Clin Exp Ophthalmol. 2014;252:509–514. doi: 10.1007/s00417-013-2480-7.
    1. del Pilar CM, Garcia-Munoz A, Garcia-Bernabeu JR, Lopez A. Comparison between MEM and Nott dynamic retinoscopy. Optom Vis Sci. 1999;76:650–655. doi: 10.1097/00006324-199909000-00023.
    1. Garcia A, Cacho P. MEM and Nott dynamic retinoscopy in patients with disorders of vergence and accommodation. Ophthalmic Physiol Opt. 2002;22:214–220. doi: 10.1046/j.1475-1313.2002.00026.x.
    1. Gwiazda J, Thorn F, Bauer J, Held R. Myopic children show insufficient accommodative response to blur. Invest Ophthalmol Vis Sci. 1993;34:690–694.
    1. Nakatsuka C, Hasebe S, Nonaka F, Ohtsuki H. Accommodative lag under habitual seeing conditions: comparison between myopic and emmetropic children. Jpn J Ophthalmol. 2005;49:189–194. doi: 10.1007/s10384-004-0175-7.
    1. Rosenfield M, Gilmartin B. Effect of target proximity on the open-loop accommodative response. Optom Vis Sci. 1990;67:74–79. doi: 10.1097/00006324-199002000-00002.
    1. Jimenez R, Martinez-Almeida L, Salas C, Ortiz C. Contact lenses vs spectacles in myopes: is there any difference in accommodative and binocular function? Graefes Arch Clin Exp Ophthalmol. 2011;249:925–935. doi: 10.1007/s00417-010-1570-z.
    1. Borsting E, Chase C, Tosha C, Ridder WH., 3rd Longitudinal study of visual discomfort symptoms in college students. Optom Vis Sci. 2008;85:992–998. doi: 10.1097/OPX.0b013e31818883cd.
    1. Borsting E, Chase CH, Ridder WH., 3rd Measuring visual discomfort in college students. Optom Vis Sci. 2007;84:745–751. doi: 10.1097/OPX.0b013e31812f5f51.
    1. Borsting E, Tosha C, Chase C, Ridder WH., 3rd Measuring near-induced transient myopia in college students with visual discomfort. Optom Vis Sci. 2010;87:760–766. doi: 10.1097/OPX.0b013e3181f31f4e.
    1. Drew SA, Borsting E, Escobar AE, Liu C, Castellanos E, Chase C. Can chronic visual discomfort measures accurately predict acute symptoms? Optom Vis Sci. 2013;90:1149–1155. doi: 10.1097/OPX.0000000000000006.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する