Abstract
Purpose:To analyze the changes in the binocular vision parameters after bilateral Epilasik laser vision correction surgery (LVCS).Setting:Medical Research Foundation, Tamil Nadu, India.Study design:Prospective cohort study.Methods:Subjects with a best corrected visual acuity of ≤ 0.0 Log MAR scale and refractive error: < 6.00DS of myopia, < 0.75D of astigmatism, and < 1D of anisometropia were included in the study. All subjects underwent a comprehensive eye examination, LVCS workup which included corneal topography, tomography, aberrometry, and dry eye assessment prior to binocular vision assessment. Complete Binocular vision assessment which included stereopsis, fusion for distance and near, near point of convergence, phoria measurement, vergence amplitudes and facility, accommodative amplitudes, response, and facility was performed with the best corrected vision prior to LVCS, one month and six months after the surgery.Results:Twenty-five subjects of age 23.8 ± 2.9 years were included. Age ranged from 20 to 32 years. Ten were female and 15 were male. The median spherical power was –2.00DS with an inter quartile range (IQR) of –1.50DS to –3.00DS for both eyes. The median cylindrical power was plano with IQR –0.50DC to –1.00DC for both eyes. There was a statistically significant decrease in monocular and binocular accommodative amplitudes (accounting for age-related changes) as well as positive fusional vergence recovery for near between baseline and one month after surgery (p < 0.05).Conclusion:Though subjects were asymptomatic post LVCS, still there is an indication that myopic LVCS could precipitate or aggravate an existing non-strabismic binocular vision anomaly. Comprehensive binocular vision assessment and appropriate management is recommended before and after LVCS.
Highlights
Often after Laser Vision Correction Surgery (LVCS), patients may complain of blurred vision despite a well centered treatment, good corneal healing, and negligible refractive error (Day, Powers & Faktorovich 2005)
Though subjects were asymptomatic post LVCS, still there is an indication that myopic LVCS could precipitate or aggravate an existing non-strabismic binocular vision anomaly
All consecutive subjects who were eligible for the Epilasik procedure, which was the preferred choice of treatment in low to moderate myopes, and those who fulfilled the inclusion criteria, underwent a comprehensive binocular vision (BV) assessment
Summary
Often after Laser Vision Correction Surgery (LVCS), patients may complain of blurred vision despite a well centered treatment, good corneal healing, and negligible refractive error (Day, Powers & Faktorovich 2005). Literature postulates that poor binocular vision (BV) due to fluctuations in the ocular accommodation to be one of the reasons for blurred vision in the absence of any residual refractive error (Day, Powers & Faktorovich 2005; Prakash et al 2007; Gots, Tassignon & Gobin 2004; Singh et al 2015). The ocular accommodation need would increase after myopic corneal LVCS compared to spectacle correction owing to changes in the vertex distance, especially in patients with high myopia (Prakash et al 2007). This significant increase in accommodation for near may raise concerns about asthenopia or apparent progression, especially in early presbyopia (Tsuneyoshi et al 2014). The aim of this pilot study is to analyze and understand the changes in the BV parameters before and after LVCS in young individuals, following an Epilasik procedure
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