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    Vejarano method benefits presbyopia

    Aberration modulation, double ablation profile combination provides good vision

    Dr. Vejarano
    PopayŠn, Colombia—The Vejarano Method, a PresbV treatment for presbyopia, provides good vision for patients with all refractive defects. Aberration modulation is performed in the dominant eye and a double-ablation profile is used in the central and peripheral cornea—the PresbV (Vejarano Method)—for the non-dominant eye. L. Felipe Vejarano, MD, described this new algorithm.

    "Pseudoaccommodation is achieved through better depth of focus, negative spherical aberration, against-the-rule astigmatism, and miosis," said Dr. Vejarano, in private practice in PopayŠn, Colombia. "The advantage of the new PresbV technique is that its own software can be used in the wavefront system [WaveScan, Abbott Medical Optics (AMO)].

    "The technique is reproducible and reliable for any surgeon and patient because the [wavefront system] controls everything," he said. "The surgeon needs only to input a good refraction into the computer and select the dominant and nondominant eyes, does not need any adjustment, and also does not have any change depending of the patient age."

    Dominant, nondominant eyes

    In the PresbV technique, Dr. Vejarano performs aberration modulation in the dominant eye and double ablation in the nondominant eye.

    "The binocular visual outcomes that I obtain have been excellent for any distance," he said.

    He began performing this technique in the dominant eye of patients with hyperopia (greater than +3.75 D) in October 2006 to improve the depth of focus. Patients underwent treatment (CustomVue, AMO) with slight hypercorrection with an excimer laser system (VISX STAR S4 IR, AMO) to provide pseudoaccommodation and generate negative spherical aberration by customizing the nomogram percentage.

    In March 2009, he began to use aberration modulation to treat the dominant eye of patients with myopia (greater than –1.50 D). Patients underwent treatment (CustomVue) with hypocorrection with the same laser to improve the depth of focus and try to avoid inducement of positive spherical aberration secondary to the ablation using a customized nomogram.

    His results indicated that the patients always achieved excellent far and near vision, with few complaints of halos and glare, from the first day after surgery. Thus far, some patients have been followed for more than 18 months and others for more than 3 months, Dr. Vejarano said.

    To date, he has treated 194 eyes of 110 patients with myopia, hyperopia, or astigmatism and those with emmetropia: myopia (69 eyes of 37 patients; average age, 48.03 years) ranging from –0.75 to –6.25 D, hyperopia (125 eyes of 73 patients; average age, 52.44 years) ranging from +1.25 to +6 D, emmetropia (22 eyes of 22 patients; average age, 50.81 years) ranging from +1 to –0.50 D, and all degrees of astigmatism. Eighty-three of the patients were treated binocularly.

    "Today, there is not one [single] technique that permanently corrects presbyopia," Dr. Vejarano concluded. "The PresbV [technique] provides patients with good glasses independence and excellent vision in any distance in any kind of refractive defect. The . . . technique appears to be very promising for treating presbyopia in almost every patient. Obtaining successful results with this surgery depends on the patient's needs and expectations."


    L. Felipe Vejarano, MD

    Dr. Vejarano has no financial interest in the subject matter. He described this new algorithm most recently at the 29th Pan-American Congress of Ophthalmology and at the annual meeting of the American Society of Cataract and Refractive Surgery.

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