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From VisionClinics, Utrecht, The Netherlands (MHAL); and SCHWIND eye-tech-solutions, Kleinostheim, Germany (TE, SA-M).
Mr. Ewering and Dr. Arba-Mosquera are employees of SCHWIND eye-tech-solutions. The remaining authors have no financial or proprietary interest in the materials presented herien.
Surgical correction of presbyopia continues to be one of the greatest challenges for refractive surgeons. There is increasing interest in achieving pseudo-accommodative corneas for the alleviation of presbyopic symptoms, which can be performed with the PresbyMAX (SCHWIND eye-tech-solutions, Kleinostheim, Germany).1-4 One of the major concerns about induced corneal multifocality is the reversibility of the procedure, or how easy it is to regain a monofocal cornea in case of dissatisfaction with a surgically induced multifocal cornea. Such multifocal optical systems cannot be fully corrected with conventional spectacles or contact lenses. In the case of multifocal ablation, it also remains inconclusive whether multifocal corneas (characterized by extreme high levels of aberrations, particularly spherical aberrations), can be resolved by Placido-based topography or Hartmann-Shack aberrometry and reverted back to normal corneas using a wavefront-guided approach.
To the best of our knowledge, we present the novel use of a nonwavefront-guided Presby reversal treatment targeting a monofocal cornea after bi-aspheric ablation profile applied to a patient intolerant to multifocality and wishing to have a monofocal cornea again.
Case Report
An originally myopic patient (49 years old at the time of the initial treatment) simultaneously treated for correcting distance ametropia and alleviating presbyopic symptoms resulted in intolerance to the induced multifocality in the dominant (right) eye.
Refraction values and visual acuities can be found in Table 1 . The original refraction was mild myopic astigmatism with normal corrected distance visual acuity (CDVA). The bi-aspheric multifocal treatment (Figure 1A ) resulted in low myopic astigmatism close to the target of approximately -0.5 diopters sphere (DS), but CDVA decreased by two lines. After the 3-month follow-up was completed, a corneal wavefront-guided treatment was performed (Figure 1B ) in an attempt to improve distance visual acuity. With this treatment, refraction shifted to low hyperopic astigmatism, but CDVA did not improve and the patient was still dissatisfied with the result.
Due to the persistent dissatisfaction, a nonwavefront-guided PresbyMAX reversal treatment was planned (Figure 1C ). This treatment was prepared using the SCHWIND PresbyMAX treatment planning...