Evidence for delayed presbyopia after photorefractive keratectomy for myopia.

PURPOSE

To evaluate uncorrected near visual acuity (NVA), accommodation, corneal aberrations, and the optical quality of the retinal image in presbyopic eyes after photorefractive keratectomy (PRK).

DESIGN

Nonrandomized comparative retrospective study.

PARTICIPANTS

Ten post-PRK patients and 10 normal patients.

METHODS

Twenty eyes (10 right and 10 left after PRK for myopia, minimum of 10 years after the operation; group A) were compared with 20 eyes (10 right and 10 left age- and gender-matched normal controls; group B). All subjects were over 40 years of age.

MAIN OUTCOME MEASURES

With best distance correction, NVA was measured at 40 cm (Jaeger, J series), and the range of accommodation (diopters [D]) was measured subjectively (negative relative amplitude and positive relative amplitude). The modulation transfer function (MTF) and corneal aberrations such as comalike, spherical (SAs), and higher order (HOAs) were measured with a Hartmann-Shack aberrometer. From the MTF curves, the spatial frequencies corresponding to contrast values of 0.1 and 0.5 were noted.

RESULTS

Mean ages (+/- standard deviations [SDs]) were 46.3 years (4.7) for group A and 47.6 years (4.9) for group B (P>0.05). Near acuity was J1 or better in 12 of 20 post-PRK and 4 of 20 control eyes. Mean accommodations (+/- SDs) were 3.2 D (1.14) for right group A eyes and 2.1 D (0.94) for right group B eyes (P = 0.0152), and 3.4 D (0.99) for left A eyes and 2.3 D (1.02) for left B eyes (P = 0.0168). Total HOA indexes (+/- SDs) were 1.449 (0.409) for right group A eyes and 0.824 (0.241) for right group B eyes (P = 0.008), and 1.464 (0.388) for left A eyes and 1.067 (0.542) for left B eyes (P = 0.0752). Pooling the data from post-PRK and control eyes, a significant correlation was found between near acuity and SA (right eyes, r = -0.535, P = 0.015; left eyes, r = -0.493, P = 0.027). Significant associations were found between accommodation, near acuity, HOA, and comalike aberration for right eyes only. Mean spatial frequencies (+/- SDs) corresponding to contrast values of 0.1 for right and left eyes were 14.96 (5.71) for right group A eyes and 22.02 (6.85) for right group B eyes (P = 0.074), and 15.11 (7.80) for left A eyes and 21.41 (9.00) for left B eyes (P = 0.271). Mean spatial frequencies (+/- SDs) corresponding to contrast values of 0.5 for right and left eyes were 2.86 (0.63) for right group A eyes and 3.21 (0.35) for right group B eyes (P = 0.596), and 2.76 (0.98) for left A eyes and 3.22 (0.27) for left B eyes (P = 0.194).

CONCLUSIONS

Compared with normal eyes, in previously myopic eyes treated with first-generation PRK lasers there is a tendency for (1) the optical quality of the retinal image to be reduced at low contrast, (2) the aberrations attributed to the corneal surface to increase, and (3) both measured subjective accommodation and near acuity to be greater than expected. We postulate that the corneal aberrations induced by PRK for myopia may reduce the quality of the retinal image for distance but enhance near acuity by way of a multifocal effect that can delay the onset of age-related near vision symptoms.