Visual outcomes 24 months after LaserACE

Abstract

Background: To evaluate the effects on near and intermediate visual performance after bilateral Laser Anterior Ciliary Excision (LaserACE) procedure.

Methods: LaserACE surgery was performed using the VisioLite 2.94 μm erbium: yttrium-aluminum-garnet (Er:YAG) ophthalmic laser system in 4 oblique quadrants on the sclera over the ciliary muscle in 3 critical zones of physiological importance (over the ciliary muscles and posterior zonules) with the aim to improve natural dynamic accommodative forces. LaserACE was performed on 26 patients (52 eyes). Outcomes were analyzed using visual acuity testing, Randot stereopsis, and the CatQuest 9SF patient survey.

Results: Binocular uncorrected near visual acuity (UNVA) improved from +0.20 ± 0.16 logMAR preoperatively, to +0.12 ± 0.14 logMAR at 24 months postoperatively (p = 0.0014). There was no statistically significant loss in distance corrected near visual acuity (DCNVA). Binocular DCNVA improved from +0.21 ± 0.17 logMAR preoperatively, to +0.11 ± 0.12 logMAR at 24 months postoperatively (p = 0.00026). Stereoacuity improved from 74.8 ± 30.3 s of arc preoperatively, to 58.8 ± 22.9 s of arc at 24 months postoperatively (p = 0.012). There were no complications such as persistent hypotony, cystoid macular edema, or loss of best-corrected visual acuity (BCVA). Patients surveyed indicated reduced difficulty in areas of near vision, and were overall satisfied with the procedure.

Conclusions: Preliminary results of the LaserACE procedure show promising results for restoring visual performance for near and intermediate visual tasks without compromising distance vision and without touching the visual axis. The visual function and visual acuity improvements had clinical significance. Patient satisfaction was high postoperatively and sustained over 24 months.

Trial registration: NCT01491360 (https://ichgcp.net/clinical-trials-registry/NCT01491360). Registered 22 November 2011.

Keywords: Accommodation; Asian eyes; Clinical trial; Presbyopia; Visual acuity.

Figures

Fig. 1

LaserACE surgical procedure. a the three critical zones of significance as measured from the anatomical limbus; b restored mechanical efficiency and improved biomechanical mobility (procedure objectives)

Fig. 2

LaserACE surgical technique. Photo a Quadrant marker; b Matrix marker; c Corneal Shield; d LaserACE micropore ablation; e Subconjunctival Collagen; f Completed 4 quadrants

Fig. 3

Uncorrected (lightly colored) and distance-corrected (darkly colored) visual acuity at distance (4 m) intermediate (60 cm), and near (40 cm) for a) monocular and b) binocular patient eyes. Error bars represent mean ± SD

Fig. 4

Box-and-whiskers plot of the stability of the spherical equivalent refraction of patient eyes. The upper and lower extremities of the box represent the 75 and 25th percentiles, the bar within the box represents the median, the whiskers represent the full extent of the data ranges, and the points represent outliers. The star denotes statistical significance compared to preoperative values

Fig. 5

Box-and-whiskers plot of the postoperative changes in intraocular pressure (IOP) of patient eyes. The upper and lower extremities of the box represent the 75 and 25th percentiles, the bar within the box represents the median, the whiskers represent the full extent of the data ranges, and the points represent outliers. The stars denote statistical significance compared to preoperative values

Fig. 6

Box-and-whiskers plot of the stereoacuity of patient eyes. The upper and lower extremities of the box represent the 75 and 25th percentiles, the bar within the box represents the median, the whiskers represent the full extent of the data ranges, and the points represent outliers. The star denotes statistical significance compared to preoperative values

Fig. 7

Average participant ratings from the CatQuest 9SF survey. Responses ranged from +2, indicating no difficulty, to −2, indicating great difficulty. Error bars represent mean ± SE

Fig. 8

Serial photographs of representative patients from postoperative 1 week to 2 years