Laser vision correction for low hyperopia. An 18-month assessment of safety and efficacy

OBJECTIVE: This study aimed to assess the efficacy and safety of hyperopic photorefractive keratectomy (PRK) and to evaluate the effect of degree of hyperopia, two epithelial removal methods, and various postoperative patient management techniques on clinical outcomes. DESIGN: Prospective, nonrandomized, open-label clinical trial. PARTICIPANTS: A total of 38 patients with mean follow-up of 13.9 months (n = 65 eyes with hyperopia from +1.00 diopter D] to +4.00 D) participated. INTERVENTION: Hyperopic PRK with the VISX STAR Excimer Laser System was performed. MAIN OUTCOME MEASURES: Spherical equivalent (SE) including vector analysis of SE; uncorrected visual acuity (UCVA); best-spectacle corrected visual acuity (BSCVA); low-, medium- and high-contrast visual acuities; topography; keratometry; pachymetry; and intraocular pressure, haze, and all other potential complications were measured. RESULTS: A total of 80% of eyes were within +/- 0.5 D and all but 1 eye (98%) were within +/- 1.0 D of intended manifest SE at 1 year. There was no induced astigmatism at 1 year. At 12 months, 72% of eyes had UCVA of 20/25 or better and 70% had achieved preoperative BSCVA, with no eye seeing worse than 20/25. These results remained constant at 18 months. There was a tendency toward regression between months 1 and 6 with stabilization of SEs between months 6 and 12. Thereafter, up to 18 months, there was some regression with a mean of +0.31 D, but the number of patients was small. There was one mild decentration and very slight decreases in mean intraocular pressure and central corneal thickness. One patient had grade 1.0 haze develop in both eyes at 12 and 18 months; all other patients experienced trace or no haze. There were no significant complications. CONCLUSIONS: The results of this study support the hypothesis that laser vision correction is safe and effective for treating low hyperopia. The predictability of the hyperopic laser vision correction procedure used in this study was very good. Other than the slower recovery of BSCVA and UCVA seen with this procedure, as compared with myopic PRK, there were no significant complications. The trend toward some later regression needs to be further evaluated in a larger number of patients. Overall, patients were very pleased with the treatment, even in the first 6 months.