Visual outcomes 24 months after LaserACE

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 2.94μm 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.

Scleral surgery for the treatment of presbyopia: where are we today?

Presbyopia corrections traditionally have been approached with attempts to exchange power,either at the cornea or the lens planes,inducing multifocality,or altering asphericity to impact the optical system.Treatments that affect the visual axis,such as spectacle and contact lens correction,refractive surgeries,corneal onlays and inlays,and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye.Their aim is instead to enhance‘pseudoaccommodation’by facilitating an extended depth-of-focus for which vision is sufficient.There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution,rather than a‘vision correction’solution that compromises other components of the optical system.Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia.While the theoretical justification of scleral surgical procedures remains controversial,there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia.Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s,and this remains an active area of research.In this article,we discuss the historic scleral surgical procedures,the two scleral procedures currently available,as well as an outlook of the future for the scleral surgical space for treating presbyopia.