Aim To assess visual outcomes and corneal aberration changes following micro-monovision multifocal bi-aspheric ablation (PresbyMax monocular) for presbyopia correction. Method 25 patients (50 eyes) underwent PresbyMAX monocular treatment. Pre and postoperative evaluations (1 week, 1, 3, and 6 months) included uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance visual acuity (CDVA). Corneal aberration and Strehl ratio (SR) were analyzed within 3-mm and 6-mm zones. The National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25) was used to assess visual function preoperatively and at 6 months postoperatively. Result At 6 months, binocular UDVA and UIVA were 0 (− 0.1, 0) logMAR and − 0.1 (− 0.1, 0) logRAD, respectively. Spectacle independence reached 96%, with 96%, 100%, and 96% achieving UDVA ≥ 0.1 logMAR, UIVA ≥ 0.1 logRAD, and UNVA ≥J1. No eyes lost corrected distance visual acuity. In non-dominant eyes, 3-mm corneal zones exhibited negative shifts in fourth-order spherical aberration (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\({Z}_{4}^{0}\)</EquationSource> </InlineEquation>) and sixth-order spherical aberration (<InlineEquation ID="IEq2"> <EquationSource Format="TEX">\({Z}_{6}^{0}\)</EquationSource> </InlineEquation>) (both p < 0.001). In 6-mm corneal zones, <InlineEquation ID="IEq3"> <EquationSource Format="TEX">\({Z}_{4}^{0}\)</EquationSource> </InlineEquation> exhibited no significant change; however, compared to the dominant eye, it was significantly more negative (p < 0.001). <InlineEquation ID="IEq4"> <EquationSource Format="TEX">\({Z}_{6}^{0}\)</EquationSource> </InlineEquation> increased positively with a statistically significant difference (p < 0.001). NEI-VFQ-25 scores improved from 74.63 (71.70, 81.81) to 91.15 (85.23, 93.08) (p < 0.001). Conclusion The PresbyMAX protocol enhances near vision by strategically manipulating aberrations to increase depth of focus in the non-dominant eye, while the dominant eye maintains distance and intermediate vision. This synergistic binocular approach achieves satisfactory full-range vision, resulting in a 96% spectacle independence rate and high patient satisfaction. Clinical trial registration number ChiCTR2300074821, registration date 2023-08-17.

Changes in visual acuity and corneal aberrations after presbyopia correction using micro-monovision multifocal bi-aspheric ablation: six-month results

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2026年3月25日

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Xiaofan Wang,
Li Li,
Yinuo Lin,
Peng Ji,
Yifan Tang,
Suqi Xian,
Hongsheng Bi

摘要

Aim

To assess visual outcomes and corneal aberration changes following micro-monovision multifocal bi-aspheric ablation (PresbyMax monocular) for presbyopia correction.

Method

25 patients (50 eyes) underwent PresbyMAX monocular treatment. Pre and postoperative evaluations (1 week, 1, 3, and 6 months) included uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance visual acuity (CDVA). Corneal aberration and Strehl ratio (SR) were analyzed within 3-mm and 6-mm zones. The National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25) was used to assess visual function preoperatively and at 6 months postoperatively.

Result

At 6 months, binocular UDVA and UIVA were 0 (− 0.1, 0) logMAR and − 0.1 (− 0.1, 0) logRAD, respectively. Spectacle independence reached 96%, with 96%, 100%, and 96% achieving UDVA ≥ 0.1 logMAR, UIVA ≥ 0.1 logRAD, and UNVA ≥J1. No eyes lost corrected distance visual acuity. In non-dominant eyes, 3-mm corneal zones exhibited negative shifts in fourth-order spherical aberration ( \({Z}_{4}^{0}\) ) and sixth-order spherical aberration ( \({Z}_{6}^{0}\) ) (both p < 0.001). In 6-mm corneal zones, \({Z}_{4}^{0}\) exhibited no significant change; however, compared to the dominant eye, it was significantly more negative (p < 0.001). \({Z}_{6}^{0}\) increased positively with a statistically significant difference (p < 0.001). NEI-VFQ-25 scores improved from 74.63 (71.70, 81.81) to 91.15 (85.23, 93.08) (p < 0.001).

Conclusion

The PresbyMAX protocol enhances near vision by strategically manipulating aberrations to increase depth of focus in the non-dominant eye, while the dominant eye maintains distance and intermediate vision. This synergistic binocular approach achieves satisfactory full-range vision, resulting in a 96% spectacle independence rate and high patient satisfaction.

Clinical trial registration number

ChiCTR2300074821, registration date 2023-08-17.