Clinical outcomes of presbyopia correction with the latest techniques of presbyLASIK: a systematic review.

The aim of this study was to collect the scientific literature on the correction of presbyopia with laser in situ keratomileusis (presbyLASIK) in last years and to analyse the quality of such scientific evidence using a validated methodology for conducting a systematic review. A total of 42 articles were initially identified, but after applying the selection criteria and an additional manual search a total of 23 articles were finally included: 2 non-randomized controlled clinical trials (NRCT) and 21 case series. Quality assessment of NRCTs and case series was performed with the ROBINS-I and the 20-criterion quality appraisal checklist defined by Moga et al. (IHE Publ 2012), respectively. For NRCT, the risk of bias was moderate in one study and serious in the other NRCT, being the main sources of risk, the domains related to confounding, selection of participants and measurement of outcomes. For case series studies, the main source of risk of bias was subjects not entering the study at the same point of the conditions (different levels of presbyopia). Likewise, a significant level of uncertainty was detected for the following items: consecutive recruitment of patients, blinding of outcome assessors to the intervention that the patient received, and conclusions of the study not supported by the results. Research on presbyLASIK to this date is mainly focused on case series generating a limited level of scientific evidence. The two NRCTs identified only demonstrated the potential benefit of combining the multiaspheric profile with some level of monovision in the non-dominant eye.