Femtosecond laser in situ keratomileusis versus conductive keratoplasty to obtain monovision in patients with emmetropic presbyopia Mohammad Ghassan Ayoubi, MD, MsCOphth, MRCOphth, FRCS, Antonio Leccisotti, MD, PhD, Edward A. Goodall, PhD, Victoria E. McGilligan, PhD, Tara C.B. Moore, PhD PURPOSE: To compare visual outcomes, complications, and patient satisfaction after femtosecond laser in situ keratomileusis (LASIK) and conductive keratoplasty (CK). SETTING: Private laser clinics, Reading and Southampton, United Kingdom. METHODS: In this retrospective consecutive single-surgeon comparative study, presbyopic emmetropia was treated with femtosecond LASIK or CK to achieve monovision by targeting 1.50 diopters (D) of myopia in the nondominant eye after a successful monovision contact lens trial. The CK treatments were performed with a ViewPoint CK system using the light-touch technique. The femtosecond LASIK was performed using an IntraLase FS/FS30 and EC-5000 platform with OPDCAT wavefront treatment. RESULTS: The mean spherical equivalent 12 months postoperatively was 1.63 D G 0.68 (SD) in the femtosecond LASIK group and 0.97 G 0.82 D in the CK group (P<.001). The mean vector value of astigmatism at 12 months was 0.32 G 0.32 D and 1.00 G 0.75 D, respectively (P<.0001). The mean induced higher-order aberration (HOA) was 0.45 G 0.28 mm in the femtosecond LASIK group and 1.13 G 0.25 mm in the CK group (P<.0001). The retreatment rate was 3% after femtosecond LASIK and 50% after CK (P<.0001). On a questionnaire administered at 12 months, 20 patients (62.5%) in the femtosecond LASIK group and 11 patients (34.4%) in the CK group reported being satisfied (P Z .02). CONCLUSIONS: In emmetropic presbyopic cases, femtosecond LASIK monovision provided stable correction with less induced astigmatism and HOA. Eyes with CK monovision had regression and induced astigmatism. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. J Cataract Refract Surg 2010; 36:997–1002 Q 2010 ASCRS and ESCRS Monovision is a method of presbyopic correction in which 1 eye (usually the dominant) is optically cor- rected for distance vision and the other eye for near vi- sion. 1,2 Monovision can be achieved by contact lenses, 3 intraocular lenses, 4 conductive keratoplasty (CK), 5 photorefractive keratectomy (PRK), 6 and laser in situ keratomileusis (LASIK). 7 In general, up to 1.50 diop- ters (D) of myopia are induced in the nondominant eye. The induction of monovision in emmetropic pa- tients remains controversial because it entails a refrac- tive procedure in a healthy eye with good distance visual acuity. The U.S. Food and Drug Administration (FDA) granted approval of CK for temporary induc- tion of myopia in the nondominant eye of presbyopic emmetropic patients in 2004. 8 The FDA approved LASIK treatment to achieve monovision in 2007. A Conductive keratoplasty shrinks the corneal colla- gen using radiofrequency energy. It is most often used to steepen the central cornea in patients with hy- peropia or to treat presbyopia in cases of emmetropia or mild hyperopic presbyopia. 9 There are few reports of the efficacy of excimer laser correction of monovision in presbyopic patients. 6,10,11 Myopic monovision correction with PRK has a reason- able satisfaction rating. 6 A study of excimer laser PRK and LASIK to correct presbyopic monovision achieved satisfactory outcomes in 88% of patients. 11 Hyperopic LASIK may induce an aspheric cornea, which can Q 2010 ASCRS and ESCRS Published by Elsevier Inc. 0886-3350/$dsee front matter 997 doi:10.1016/j.jcrs.2009.12.035 ARTICLE