CLINICAL SCIENCE
Symmetrical Versus Asymmetrical PresbyLASIK: Results
After 18 Months and Patient Satisfaction
José R. Soler Tomás, MD, PhD, Graciana Fuentes-Páez, MD, and Sergio Burillo, DDO
Purpose: The aim of this study was to report visual, topographic,
and satisfaction comparative results between symmetrical and
asymmetrical presbyLASIK after 18 months.
Methods: Longitudinal, comparative case series of hyperopic
presbyopes who underwent presbyLASIK, in a private clinical
setting. Monovision symmetrical (plano target both eyes) versus
asymmetrical [dominant eye (DE) = plano target; nondominant eye
(NDE) = 20.50 diopter (D) target]. Pre- and postoperative variables
included monocular and binocular, distance and near, uncorrected
visual acuity (VA), best corrected visual acuity, spherical equivalent,
addition (Add), topography SimK (Km), and topographic astigma-
tism. Topographic central corneal power increase was measured 3
and 18 months postoperatively. Data were reported as mean, range,
and standard deviation and analyzed with Student t-test (P , 0.05
for statistical significance) and Pearson correlation coefficients.
Results: The symmetrical group consisted of 16 patients and the
asymmetrical group of 14 patients, with a mean age of 53.5 6 2.3
and 51.9 6 2.5 years. Postoperative results, after 18 months, for
symmetrical versus asymmetrical presbyLASIK were as follows:
distance UCVA 0.8 60.20; 0.9 6 0.2 (P , 0.01); near UCVA 0.9
6 0.2; 0.8 6 0.2 (P , 0.01); SE 20.20 6 0.50; 20.3 6 0.3D (P ,
0.01); Add 0.5 6 0.5; 0.9 6 0.9 (P , 0.01); mean Km 44.8 6 1 D;
43.9 6 1.1 D (P , 0.01); mean central corneal power differential
1.4 6 0.8 D; 1.7 6 1.1 D (P , 0.01), respectively. Stability: 20.16
D, DE 20.13 D and NDE 20.16 D, and SE predictability 20.40;
DE 20.28 D and NDE 20.53 D. Safety index 1.0; 1.0, efficacy
distance VA 0.8; 0.9, and near VA 0.90; 0.8. More than 90% were
within 60.50 D of the intended target. Twenty eyes required
enhancement, and results were not significantly different. Mean
satisfaction (0–10 points) for symmetrical patients was 7.0 6 2.6 and
7.3 6 2.8 points for asymmetrical patients.
Conclusions: Symmetrical and asymmetrical presbyLASIK sig-
nificantly improved distance UCVA, near UCVA, after 18 months.
Key Words: cornea, hyperopia, presbyLASIK, presbyopia, supracor
(Cornea 2015;34:651–657)
Received for publication April 15, 2014; revision received November 5,
2014; accepted November 7, 2014. Published online ahead of print April
1, 2015.
From the Cornea and Anterior Segment Department, Clinica Oftalnova, Desp.
198–199, Centro Medico Teknon, Calle Vilana, Barcelona, Spain.
The authors have no funding or conflicts of interest to disclose.
Reprints: Jose R. Soler, MD, PhD, Centro Medico Teknon, Calle Vilana 12
Clinica Oftalnova Des 198-199, Barcelona, Barcelona, Spain (e-mail:
pete-sol@telefonica.net).
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Cornea  Volume 34, Number 6, June 2015
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C orneal multifocality for presbyopia correction has been
developing ever since McDonnell et al1 and Moreira et al2
reported improved near vision in radial keratotomy and post-
laser in situ keratomileusis (LASIK) patients. Ruiz3 intro-
duced the term “presbyLASIK” in 1996 to describe the
multifocal surface created with LASIK surgery that induced
pseudoaccommodation. Corneal pseudoaccommodation has
been reported with central presbyLASIK (central hyper-
positive cornea for near vision) and peripheral presbyLASIK
(flatter central cornea providing distance vision and curved
midperiphery for near vision) techniques; and monovision,
both conventional and crossed, has also been widely and
successfully used as an option for presbyopia.3–23 Monofocal
peripheral presbyLASIK has also been reported as
another successful option for presbyopia.12 The Supracor
presbyLASIK algorithm (designed by Technolas/ZYOPTIX
Tissue Saving Algorithm), using a symmetrical (target 20.5
diopters [D] of both eyes for patients demanding good near
vision) or asymmetrical (plano target dominant eye [DE]
and 20.5-D target nondominant eye [NDE]) for patients
demanding distance and near vision approach, creates
a biaspheric multifocal corneal profile by performing central
ablation for near vision (central 3-mm zone) and paracentral
ablation for distance vision (multifocal corneal profile over
a 6-mm optical zone). Short-term uncorrected visual acuity
(UCVA) improvement and high spectacle independence using
this presbyLASIK technique have been reported after 6
months.22,23 We report clinical results in hyperopic presbyopes
who underwent bilateral symmetrical or asymmetrical
presbyLASIK, followed up during 18 months.
MATERIALS AND METHODS
This study was performed as a prospective, longitudinal
case series of hyperopic presbyopes undergoing this central
presbyLASIK technique. The protocol was approved by our
center’s Ethics Committee, complying with the 1995 Decla-
ration of Helsinki, and selection was based on the following
patient inclusion criteria:
Hyperopic presbyopes seeking independence from
reading glasses who understood and signed an informed
consent form, +1 to +2.5 D mean refractive spherical
equivalent (SE), up to 1-D astigmatism, maximum difference
between subjective and cycloplegic refraction # +0.5, and
tolerance to the simulation test of decreased distance vision.
Eye dominance (motor) was determined using a DE “hole in
the card test.” The patient held a card with a hole in the
middle, using both hands, and was asked to view a 6-m target
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 Soler Tomás et al
through the hole in the card. The optometrist then occluded
each eye alternately to establish which eye was aligned with
the hole and the distance target. The selected eye was
considered the DE. In addition, the Worth test was performed
to exclude patients with marked eye dominance.
The distance UCVA was registered. A trial frame with
the best distance correction on both eyes was then tested with
a +0.5 sphere addition, to simulate potential blur (DE
penalization) induced by multifocality. If the visual acuity
(VA) was unchanged, or if the patient felt visually comfort-
able, he or she underwent central presbyLASIK. The
presbyLASIK treatment profile induces pseudoaccommoda-
tion by performing a hyperpositive central 3-mm curvature
(20.5 D or plano target), hence the inclusion of $3-mm
photopic pupil diameters, followed by paracentral ablation for
distance VA, thus providing corneal multifocality. Peripheral
6-mm optical zone ablation limits presbyLASIK to mesopic
pupil diameters of up to 6.5 mm, to achieve optimal distance
vision. Km between 42 D and 44 D, near addition #+2 D
needed, both eyes with best-corrected visual acuity (BCVA)
$0.8 (decimal scale and Snellen scales), kappa angle ,10
degrees, no previous corneal surgery, and corneal topography
(compatible for LASIK procedure). Photopic pupils were to
measure at least 3.00 mm and mesopic pupils within the 4.00
to 6.5 mm range (Colvard) to benefit from pseudoaccommo-
dation induced after presbyLASIK ablation. After completing
a questionnaire regarding patients’ visual needs (profession,
use of computers, reading habits, driving, and whether or not
they were willing to sacrifice distance vision to read without
glasses), patients were grouped based on visual needs. Those
demanding independence from reading glasses and willing to
sacrifice distance vision were included in the symmetrical
group (20.5-D target for both eyes), and those who were not
willing to lose distance vision were included in the asym-
metrical group (DE targeted to 0 and the NDE to 20.5 D).
Symmetrical or asymmetrical presbyLASIK ablation
was performed, after standard flap creation with the
ZYOPTIX XP microkeratome (Technolas Perfect Vision
GmbH, Munich, Germany), and ablation was performed with
the Technolas 217P Excimer Workstation (standardized
6-mm optical zone). Ocular alignment was aimed between
the apex and pupil center, using the Advanced Control Eye
tracking System, throughout the entire treatment. Data were
reported as preoperative and postoperative means and 6SD
for monocular and binocular far/near UCVA (SE), subjective
refraction, addition (Add), topography Sim K (Km) and
central corneal power differential (Orbscan v 3.14, Bausch
& Lomb), higher-order aberrations (HOA) root mean square
(RMS), Z400, and Z300 for a 6-mm pupil (Zywave 5.2
Aberrometer; Technolas Perfect Vision GmbH, Munich,
Germany), whereas Student t (paired and unpaired) and
coefficient correlations were calculated using the Microsoft
Excel 2008 for Mac program (121.0 version; 2007 Microsoft
Corporation); (P # 0.05 for statistical significance).
Enhancement was performed (symmetrical mean 7 6
2.3 months; asymmetrical 5.1 6 3.5 months) in patients who
manifested postsurgical unsatisfactory binocular visual re-
sults. The resulting monocular and binocular distance and
near refractions that provided the best binocular far and near
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Cornea  Volume 34, Number 6, June 2015
VAs were then enhanced with the laser. Symmetrical and
asymmetrical presbyLASIK results were analyzed after 3
months and were followed up for at least 18 months, whether
or not enhancement had been performed.
Safety (postoperative/preoperative BCVA ratio), effi-
cacy (postoperative UCVA/preoperative BCVA ratio), pre-
dictability (final SE deviation from programed target), and SE
stability were followed up.21 The satisfaction and difficulty
questionnaire (cataract TyPE Spec questionnaire) was
modified—General satisfaction (0–10 points), Reading satis-
faction (0–10 points), distance, near, and intermediate vision
difficulties (0–4 points, each), halos difficulty (0–4 points,
activities that required additional spectacle use, and whether
or not they would repeat the procedure)—and was translated
into Spanish for patient completion, both at the medical center
or online.24
RESULTS
Preoperative variables for symmetrical and asymmetri-
cal presbyLASIK, respectively, included: men 11, 8; women
5, 4; mean pachymetry 556 6 26.4 mm, 565 6 0.3 mm; sphere
1.5 6 0.7 D, 1.4 6 0.6 D; astigmatism 20.3 6 0.4 D, 20.2 6
0.2 D; pupil 5.3 6 0.6 mm, 5.6 6 0.6 mm; and right eye
dominance was registered for 17 patients and left eye
dominance for 12 patients.
Mean preoperative results (P . 0.01) for symmetrical
and asymmetrical eyes, respectively, are: 53.5 6 2.3 years,
51.9 6 2.5 years; distance UCVA 0.5 6 0.3 (20/40), 0.5 6
0.2 (20/40); near UCVA 0.1 6 0.04 (20/200), 0.2 6 0.2 (20/
100); SE 1.3 6 0.7 D; 1.2 6 0.7 D; Addition 1.6 6 1, 2 6
0.4; and Km 43.8 6 0.8 D, 43.9 6 1.2 D.
Mean results comparison, between the symmetrical
versus asymmetrical presbyLASIK groups after 3 months,
included mean monocular far UCVA 0.8 6 0.2 (20/25),
0.9 6 0.2 (20/20) (P , 0.01); mean monocular near UCVA
0.8 6 0.3 (20/25), 0.8 6 0.2 (20/23) (P , 0.01); mean
binocular far VA 1 6 0.007 (20/20), 1 (20/20) (P , 0.01);
mean binocular near VA 0.8 6 0.3 (20/25), 0.8 6 0.2 (20/
23.5) (P , 0.01); mean SE 20.4 6 0.4, 20.3 6 0.3 (P ,
0.01); mean Km 44.8 6 1 D, 43.9 6 1.1 D (P , 0.01); and
topographical astigmatism 20.6 6 0.6 D, 20.8 6 0.3 D (P .
0.01). Mean spherical results for the symmetrical versus the
asymmetrical groups were 20.2 6 0.3 D and 20.1 6 0.3 D,
respectively (P . 0.01). Mean postoperative cylinder results
were 20.3 6 0.2 D for the symmetrical group and 20.3 6
0.3 D for the asymmetrical group (P . 0.01). The mean
differential corneal power was 2 6 0.9, 1.4 6 0.9 (P , 0.05).
DE laser enhancement of residual refraction, which improved
distance VA without losing near VA, was performed in 33%
of all eyes, 41% (13 eyes) from the symmetrical group and
25% (7 eyes) from the asymmetrical group. These patients
were followed up for at least 18 months after enhancement.
All remaining eyes were also followed up for 18 months.
Table 1 summarizes mean final postoperative results, after 18
months, for symmetrical and asymmetrical presbyLASIK. No
eyes lost BCVA lines. Three- and 18-month comparison
for presbyLASIK eyes included distance UCVA 0.8 6 24
(20/25), 0.8 6 0.2 (20/25); near UCVA 0.8 6 0.3 (20/25),
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 Cornea  Volume 34, Number 6, June 2015 Symmetrical Versus Asymmetrical

TABLE 1. Mean Results 18 Months After PresLASIK

PresbyLASIK Only Results Distance UCVA, Near UCVA, Addition, Topography Central Corneal
(18-Month Follow-up), Mean (SD) Decimal (Snellen) Decimal (Snellen) D Km, D SE, D Power, D
All (N = 40 eyes) 0.9 6 0.2, 20/22 0.8 6 0.2, 20/23.5 0.7 6 0.5 44.3 6 1 20.2 6 0.4 1.6 6 1
P* ,0.01 ,0.01 ,0.01 ,0.01 ,0.01
Symmetrical (N = 19 eyes) 0.8 6 0.2, 20/23.5 0.9 6 0.2, 20/22 0.5 6 0.5 44.9 6 0.9 20.2 6 0.5 1.4 6 0.8
P* ,0.01 ,0.01 ,0.01 ,0.01 ,0.01
Asymmetrical (N = 21 eyes) 0.9 6 0.2, 20/22 0.8 6 0.2, 20/25 0.9 6 0.9 44.0 6 0.9 20.3 6 0.3 1.7 6 1.1
P* ,0.01 ,0.01 ,0.01 ,0.01 ,0.01
Symmetrical versus asymmetrical, P† .0.01 .0.01 .0.01 #0.01 .0.01 ,0.01
Visual, SE, Km, and addition results were statistically significant for both groups. Between groups, Km and corneal power differences were significant.
*Paired P # 0.05 (Student t).
†Unpaired Student t (pre–post).

0.8 6 0.2 (20/25); SE 20.4 6 0.4 D, 20.2 6 0.4 D; Addition
0.5 6 0.7, 0.8 6 0.8 D; and corneal power 1.9 6 0.9, 1.6 6
0.9 D. Unpaired Student t test results were P . 0.01 for all
variables.
Mean results for asymmetrical presbyLASIK only (DE
and NDE, respectively) were the following: distance UCVA
0.9 6 0.1 (20/22), 0.8 6 0.2 (20/23.5) (P , 0.01); near
UCVA 0.7 6 0.2 (23/23.5), 0.9 6 0.2 (20/22) (P , 0.01);
addition 0.9 6 0.4 D, 0.9 6 0.4 D (P , 0.01); topography
Km 44.1 6 1, 43.9 6 0.9 (P , 0.01); SE 20.2 6 0.4
D, 20.2 6 0.4 D (P , 0.01); and central corneal power 1.1 6
0.6, 2.5 6 0.8 (P , 0.01). Paired Student t test results for DE
versus NDE were P , 0.01 for central corneal power and P .
0.01 for the remaining variables.
Mean results for enhanced eyes are summarized in
Table 2. Figure 1 summarizes visual results for symmetrical
and asymmetrical presbyLASIK patients. Figure 2 shows
results for topographic central corneal power differential
between 3 and 18 months for all, presbyLASIK only, and
enhanced eyes. Figure 3 shows postsurgical topographical
corneal profiles and power differentials in DE and NDE.
PrepresbyLASIK and postpresbyLASIK aberrometry results,
respectively, for the symmetrical group were total RMS 0.9 6
0.7, 0.7 6 0.3; HOA 0.2 6 0.2, 0.3 6 0.2; Z400 0.2 6 0.04,
0.04 6 0.1; and Z300 coma 0.1 6 0.1, 0.01 6 0.3. For the
asymmetrical group, total RMS was 0.7 6 0.1, 0.5 6 0.3;
HOA 0.2 6 0.2, 0.3 6 0.2; Z400 0.04 6 0.04, 0.01 6 0.02;
and Z300 coma 0.1 6 0.1, 0.2 6 0.2 (P . 0.01). Pre- and
post-HOA for the NDE were 0.04 6 0.1, 0.4 6 0.2 (P ,
0.05). PresbyLASIK indexes and predictability results are
listed on Table 3, whereas stability results are listed on
Table 4. The following Pearson correlations (R) were
recorded: R = 20.2 for near UCVA/SE (symmetrical R =
20.4; asymmetrical R = 20.3), R = 0.2 for near UCVA/
corneal power (symmetrical R = 0.2; asymmetrical R = 0.2),
R = 20.6 for SE/corneal power (symmetrical R = 20.7;
asymmetrical R = 20.4), and R = 20.3 for addition/corneal
power (symmetrical R = 20.3; asymmetrical R = 20.2).
Table 5 summarizes patient satisfaction questionnaire results.
DISCUSSION
Multifocal corneal LASIK ablation for presbyopia, or
“presbyLASIK,” is currently an alternative to multifocal
pseudophakia in young hyperopic and myopic presbyopes.
Multiple reports have validated it as a reasonable option for
VA improvement and spectacle independence.8–15,20,22,23 The
biaspheric ablation profile is a new central presbyLASIK

TABLE 2. Mean Results Comparison for Enhanced Symmetrical and Asymmetrical Groups
PresbyLASIK and Posterior
Enhancement Results (18-Month Distance UCVA, Near UCVA, Decimal Addition, Topography Central Corneal
Follow-up), Mean (SD) N = No. Eyes Decimal (Snellen) (Snellen) D Km, D SE, D Power, D
All eyes (N = 20) 0.9 6 0.1, 20/22 0.8 6 0.1, 20/23.5 0.9 6 0.6 44.1 6 1.2 20.2 6 0.3 1.5 6 0.8
P* ,0.01 ,0.01 ,0.01 ,0.01 ,0.01
Symmetrical (N = 13) 0.9 6 0.1, 20/23.5 0.8 6 0.2, 20/22 0.9 6 0.6 44.5 6 0.9 20.2 6 0.3 1.1 6 0.6
P* ,0.01 ,0.01 ,0.01 ,0.01 ,0.01
Asymmetrical (N = 7) 0.9 6 0.1, 20/22 0.8 6 0.2, 20/25 0.8 6 0.6 43.4 6 1.2 20.1 6 0.3 1.2 6 1.2
P* ,0.01 ,0.01 ,0.01 ,0.01 ,0.01
Symmetrical versus asymmetrical, P† .0.01 .0.01 .0.01 #0.01 .0.01 .0.01
Supracor versus enhanced, P† .0.01 .0.01 .0.01 .0.01 .0.01 .0.01
Eighteen months after enhancement, visual, SE, Km, and Addition results were statistically significant for both groups. Greater Km for the symmetrical groups was found to be
statistically significant. No differences were found between presbyLASIK and enhanced eyes.
*Paired P # 0.05 (Student t).
†Unpaired Student t (pre–post).

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 Soler Tomás et al
FIGURE 1. Mean postoperative re-
sults for patients with UCVA $0.8.
Patients from the asymmetrical
group reported better monocular
distance UCVA, whereas those from
the symmetrical group reported
better monocular near UCVA. Bin-
ocular distance and near UCVA were
20/20 for both groups.
technique that offers short-term spectacle independence and
UCVA improvement in presbyopic hyperopes.22,23 Our
results show that 84% (symmetrical) and 90% (asymmetrical)
achieved $20/25 distance UCVA. One hundred percent had
20/20 binocular distance and, at least, 20/25 near UCVA.
More than 85% of eyes, in presbyLASIK and enhanced
groups, had $20/25 distance UCVA. Other authors have
reported similar findings.8,10,11
In the asymmetrical group, DE distance UCVA results
were better than for the nondominant (NDE) (P . 0.01),
whereas the near UCVA was better in the NDE than in the DE
(P , 0.05). The fact that the final mean NDE central corneal
power was higher than the DE would explain this finding (P ,
0.01). Our final presbyLASIK mean monocular near vision
results (0.9 vs. 0.8 for the symmetrical vs. asymmetrical,
respectively) are similar to those reported by other au-
thors.2,8,14,20 Seventy-two percent of eyes from the symmetrical
group had a final $20/25 monocular near UCVA compared
with 64% in the asymmetrical group. These findings are similar
to other reports.8,10,11,14,20 All postoperative monocular and
binocular results were statistically significant.
Postsurgical enhancement has been reported in 22% of
cases; 6 months after similar presbyLASIK techniques.22 We
reported a higher percentage of enhancements, perhaps because
of a longer follow-up period. No statistically significant
differences were found after comparing postoperative results
between presbyLASIK only and enhanced eyes.
FIGURE 2. Mean central power at 3
and 18 months after presbyLASIK,
for all groups.
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Cornea  Volume 34, Number 6, June 2015
PostpresbyLASIK near UCVA had a weak negative
correlation to SE. PostpresbyLASIK mean SE stability,
assessed by registering differences between months 3 and 18,
was 20.2 D SE (all eyes) and 20.2 D mean SE decrease for
both symmetrical and asymmetrical eyes, respectively. Other
authors have reported short-term final SE ranging from 0.3 to
20.5 D and greater SE instability for hyperopes.8,10–12,15,20 The
final mean SE for all eyes was 20.2 D, 20.2 D for the
symmetrical group and 20.3 D for the asymmetrical group
(P , 0.01). No significant differences were found when
comparing symmetrical versus asymmetrical results.
Regarding mean postoperative addition results, we
report a statistically significant decrease in mean addition
for all groups. Our mean results (0.9 D for all eyes) are lower
than those previously reported.10 No significant findings were
registered after comparing both symmetrical and asymmetri-
cal groups’ addition needs.11
In our presbyLASIK patients, the mean final central
corneal power (pseudoaccommodation) was higher for the
asymmetrical group, 2 versus 1.4 D than for the symmetrical
group (P , 0.01). Significant corneal power differences were
also found between DE and NDE (P , 0.01). No significant
differences were registered between the symmetrical and
asymmetrical eyes from the enhancement group. Three- and
18-month topography central corneal power differentials
registered a significant decrease for both symmetrical and
asymmetrical presbyLASIK groups (P , 0.01). Central
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 Cornea  Volume 34, Number 6, June 2015 Symmetrical Versus Asymmetrical

FIGURE 3. A and B, Topographies display postsurgical corneal profile, representing a central power increase in an asymmetrical
patient; left DE corneal profile (2.8-D power differential) and right NDE corneal profile (1.8-D power differential).

power also significantly decreased in time, both in the loss was registered for both symmetrical and asymmetrical
presbyLASIK only and in the presbyLASIK with enhance- groups (P . 0.01). Our results are lower than the 0.4-D loss
ment groups. Central corneal power had a positive correlation reported for standard hyperopic LASIK, after 12 months.25
to near UCVA and a weak negative correlation to SE, for both Posthyperopic LASIK regression has been attributed to post-
groups. This indicates that pseudoaccommodation, induced surgical epithelial asymmetry registered with very high-
by the presbyLASIK ablation, was partly responsible for the frequency ultrasound.26 Surprisingly, central epithelial thinning
reported near UCVA and SE changes. occurs after hyperopic LASIK, thus adding to the magnitude of
PresbyLASIK was reported as safe (1 safety index for corneal flattening and undercorrection.26 They also argued that
near and far VA), had .0.8 efficacy for monocular VA
improvement, and excellent binocular far and near VA efficacy
(1 efficacy index), after 18 months. Excellent short-term safety
indexes for both distance and far UCVAs have already been TABLE 4. PresbyLASIK Stability, After 18 Months
reported for central and peripheral presbyLASIK.8–10,12 PresbyLASIK +
Regarding stability, all eyes had a 0.2 D mean regression PresbyLASIK SE PresbyLASIK Only Enhancement (Mean SE;
(P . 0.01). Enhanced eyes lost 0.2 D (P , 0.05), and a 0.2-D Stability (Mean SE; SD in D) SD in D)
All eyes 3 mo: 20.4 6 0.5 3 mo: 20.4 6 0.4
18 mo: 20.2 6 0.4 18 mo: 20.2 6 0.4
TABLE 3. PresbyLASIK Procedure Safety/Efficacy Indexes and P* .0.01 ,0.05
Predictability: 18-Month Follow-up 0.2 D mean regression 0.2 D mean regression
Postoperative Symmetrical eyes 3 mo: 20.5 6 0.6 D 3 mo: 20.4 6 0.4 D
Indexes (18-Month Predictability, SE, D 18 mo: 20.2 6 0.5 D 18 mo: 20.2 6 0.3 D
Follow-up) Safety Efficacy (Target) P* .0.01 .0.01
Symmetrical 0.3 D mean regression 0.2 D mean regression
Supracor Far: 1 Far: 0.8 20.2 D (20.5) Asymmetrical eyes 3 mo: 20.4 6 0.5 D 3 mo: 20.4 6 0.6 D
(N = 19 eyes) Near: 1 Near: 0.9 18 mo: 20.2 6 0.3 D 18 mo: 20.2 6 0.4 D
Enhanced Far: 1 Far: 0.9 20.2 D (20.5 D) P* £0.05 .0.01
(N = 13 eyes) Near: 1 Near: 0.8 0.2 D mean regression 0.2 D mean regression
Asymmetrical Symmetrical versus .0.01 .0.01
Supracor Far: 1 Far: 0.9 Overall: 20.3 D; DE: asymmetrical, P†
(N = 21 eyes) Near: 1 Near: 0.8 20.2 D (plano); NDE: Mean results were within 60.50 of the intended target. SE regression was observed
20.2 D (20.5 D) for all groups; statistically significant results were found in enhanced eyes and the
Enhanced eyes Far: 1 Far: 0.9 Overall: 20.2 D; DE: asymmetrical presbyLASIK group.
(N = 7 eyes) Near: 1 Near: 0.8 20.1 (plano); NDE: *Paired Student t test (pre–post).
20.3 (20.5 D) †Unpaired Student t.

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 Soler Tomás et al
TABLE 5. Satisfaction Questionnaire Results
General Reading
Questionnaire Satisfaction Satisfaction
Results (0–10 Points) (0–10 Points)
Symmetrical 7 6 2.6 7.3 6 2
Asymmetrical 7.3 6 2.8 8.4 6 2.1
P* .0.01 .0.01
Patients in the asymmetrical group reported higher satisfaction and less difficulties after presbyLASIK, although not significant, compared with patients in the symmetrical group.
Sixty percent of symmetrical and more than 70% of asymmetrical presbyLASIK patients would repeat the procedure.
*Unpaired Student t (,0.05 = statistical significance).
the central epithelial thinning and paracentral thickening,
induced after paracentral tissue ablation, could also be
responsible for astigmatism induction.26
Predictability was similar for both symmetrical (SE 20.2
D; target 20.5) and asymmetrical groups (DE SE20.3 [plano
target] and NDE SE: 0.2 [20.5 D target]). Less than expected
induced short-term pseudoaccommodation, after presbyLASIK,
has already been reported.8 More than 90% of our patients were
within 60.5 D of the intended target.
Total aberrations decreased, whereas HOA increased in
both groups (P . 0.01). A statistically significant HOA
increase was also registered for NDE in the asymmetrical
group. This result could offer presbyopes better retinal
contrast at low spatial frequencies for both distance and near
vision.21
As previously reported, spherical aberrations decreased
in both groups (P . 0.01).8,9,12,20 Postoperative coma, due to
the resulting peripheral corneal asphericity, increased in the
asymmetrical group (P . 0.01).8
We selected the Cataract TyPE Specification question-
naire, which has been found to be valid and internally
consistent when administered in the patient care setting and
by mail survey.24 The asymmetrical group reported greater
general and vision satisfaction. The symmetrical group
reported less difficulty for intermediate vision. Other studies
have reported patient satisfaction ranging between 71% and
96%, for far vision.5,15,22 Fifty-seven percent in the symmet-
rical group and 71% from the asymmetrical group would
repeat the procedure. Enhancements, mean age .50 years,
longer follow-up, and patient unrealistic expectations could
explain these satisfaction results. Spectacle independence was
reported by all patients in the asymmetrical group, whereas
25% of patients from the symmetrical group required
additional spectacles for night reading. Results were not
statistically significant.
The statistically significant changes for postoperative
distance UCVA, near UCVA, and SE, together with the
positive correlation for near UCVA vs. corneal power (R =
0.24) and negative correlations [SE vs. corneal power (R =
20.60) and corneal power vs. Add (R = 20.23)], suggest that
the presbyLASIK ablation was partly responsible for our
findings. In addition, results between presbyLASIK only and
enhanced eyes were not significant.
Less enhancements and HOAs, in addition to signifi-
cantly higher corneal power, Km, and near UCVA results
between the DE (plano target) and NDE (20.5 D target),
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Cornea  Volume 34, Number 6, June 2015
Far Vision Near Vision Intermediate Vision Halos Would You
Difficulty Difficulty Difficulty Difficulty Repeat the
(0–4 Points) (0–4 Points) (0–4 Points) (0–4 Points) Procedure?
0.7 6 1.1 161 0.1 6 0.4 1 6 1.4 60% yes
1.5 6 1.5 1.3 6 1.5 160 0.6 6 1.5 71% yes
.0.01 .0.01 .0.01 .0.01
would likely explain why the asymmetrical group, more
likely to resemble a monovision-like situation, reported better
overall visual results and higher satisfaction and would repeat
the procedure. After 18 months, the presbyLASIK technique
was apparently safe, effective, significantly improved UCVA,
and reduced patients’ near vision spectacle dependence,
despite the recorded SE regression and corneal power loss.
ACKNOWLEDGMENTS
The authors thank Fernando Archuby, PhD, (Faculty
Member Universidad Nacional Central de la Plata, Argentina)
for his assistance with statistical analysis.
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