Transient Myopic Shift Due to Increased Latent Accommodation after LASEK

Gyu Ah Kim; Ji Min Ahn; Woo Suk Chung

doi:10.3341/jkos.2014.55.1.40

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Kim, Ahn, and Chung: Transient Myopic Shift Due to Increased Latent Accommodation after LASEK

Original Article

J Korean Ophthalmol Soc 2014;55(1):40-46.

Published online: 7 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.1.40

Transient Myopic Shift Due to Increased Latent Accommodation after LASEK

Gyu Ah Kim, MD^1,², Ji Min Ahn, MD², Woo Suk Chung, MD²

¹Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea

²Siloam Eye Hospital, Seoul, Korea

Address reprint requests to Woo Suk Chung, MD Siloam Eye Hospital, #181 Deungchon-ro, Gangseo-gu, Seoul 157-836, Korea, Tel: 82-2-2650-0880, Fax: 82-2-2650-0895, E-mail: pushong@daum.net

Received 5 February 201313 June 2013 Accepted 9 September 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate accommodation and progress of patients who showed myopia on manifest refraction in the early postoperative period after LASEK.

Methods

Forty-one eyes were included in the present study which had undergone LASEK surgery from February to March 2012. Seven eyes showed myopia over -0.25 D on manifest refraction at 1 month postoperatively, but showed decreased amount of myopia at 2 months postoperatively and were classified as group 1. The other 34 eyes were classified as group 2. The differences between cycloplegic and manifest refraction (CRSE-MRSE) were defined as the amount of latent accommodation and compared between the 2 groups.

Results

Amount of latent accommodation was 0.179 ± 0.426 D in group 1 (7 eyes), 0.265 ± 0.303 D in group 2 (34 eyes) preoperatively, 1.286 ± 0.664 D in group 1, 0.368 ± 0.536 D in group 2 at 1 month postoperatively, and 0.500 ± 0.520 D in group 1, and 0.489 ± 0.546 D in group 2 at 2 months postoperatively. The amount of latent accommodation in group 1 was significantly greater than that of group 2 one month postoperatively. As the amount of latent accommodation decreased, the amount of myopic shift decreased gradually over 2 months in group 1 after surgery.

Conclusions

Transient myopic shift due to increased latent accommodation was observed in several patients one month postoperatively and the amount of myopic shift decreased with time without treatment. Thus, surgeons should consider cycloplegic refraction when planning treatment for patients with myopic regression.

Keywords: Accommodation, Cycloplegic refraction, LASEK, Myopic shift

References

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Figure 1.

Changes in mean CRSE in group 1 and 2 over time. Note that there were no significant differences between mean CRSE values in group 1 at postoperative 1 and 2 months. An asterisk indicates significant difference at the p < 0.05 level.

Figure 2.

Changes in mean MRSE in group 1 and 2 over time. Mean MRSE in group 1 showed some myopia at postoperative 1 month but showed decreased amounts of myopic shift which was near emmetropia without treatment at postoperative 2 months. Mean MRSE in group 2 showed slight hyperopia at postoperative 1 month, but was nearly emmetropic at post-operative 2 months. ^* An asterisk indicates significant difference at the p < 0.05 level.

Figure 3.

Changes in mean CRSE-MRSE in group 1 and 2 over time. Mean values of CRSE-MRSE (amount of latent accommodation) in group 1 increased at postoperative 1 month, but decreased as much as that in group 2 at postoperative 2 months. Mean values of CRSE-MRSE (amount of latent accommodation) in group 2 showed little change with time. ^* An asterisk indicates significant difference at the p < 0.05 level.

Table 1.

General characteristics of study population

	Group 1 (n = 7)	Group 2 (n = 34)	p-value
Age (years)	20.57 ± 2.70	26.03 ± 8.08	0.134^*
Sex (male/female)	5/2	18/16	0.438^†
Preop MRSE (diopter)	-4.88 ± 2.64	-4.19 ± 2.02	0.623^*
Preop CRSE (diopter)	-4.70 ± 2.69	-3.93 ± 2.02	0.444^*
Preop UCVA (log MAR)	0.99 ± 0.38	0.95 ± 0.31	0.672^*
Preop BCVA (log MAR)	0	0	1.000^*

Values are presented as mean ± SD.

MRSE = manifested refraction spherical equivalent; CRSE = cycloplegic refraction spherical equivalent; UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity.

^* Mann Whitney test

^† Fisher’s exact test.

Table 2.

Comparison of CRSE between 2 groups

CRSE	Group 1 (n = 7)	Group 2 (n = 34)	p-value^*
Preop	-4.70 ± 2.69	-3.93 ± 2.02	0.444
POD#1Month	0.20 ± 0.86	0.44 ± 0.66	0.575
POD#2Months	-0.02 ± 0.67	0.30 ± 0.55	0.164

Values are presented as mean ± SD.

CRSE = cycloplegic refraction spherical equivalent.

^* p < 0.05 by Mann Whitney test was considered to be statistically significant.

Table 3.

Comparison of MRSE between 2 groups

MRSE	Group 1 (n = 7)	Group 2 (n = 34)	p-value^*
Preop	-4.19 ± 2.02	-4.19 ± 2.02	0.623
POD#1Month	-1.09 ± 1.04	0.07 ± 0.64	0.001
POD#2Months	-0.52 ± 0.53	-0.19 ± 0.71	0.125

Values are presented as mean ± SD.

MRSE = manifested refraction spherical equivalent.

^* p < 0.05 by Mann Whitney test was considered to be statistically significant.

Table 4.

Comparison of CRSE-MRSE between 2 groups

CRSE-MRSE	Group 1 (n = 7)	Group 2 (n = 34)	p-value^*
Preop	0.179 ± 0.426	0.265 ± 0.303	0.465
POD#1Month	1.286 ± 0.664	0.368 ± 0.536	0.002
POD#2Months	0.500 ± 0.520	0.489 ± 0.546	0.747

Values are presented as mean ± SD.

CRSE-MRSE = cycloplegic refraction spherical equivalent-manifested refraction spherical equivalent.

^* p < 0.05 by Mann Whitney test was considered to be statistically significant.

Table 5.

p-values from comparison of values of CRSE, MRSE and CRSE-MRSE between time periods (at preoperative period, 1 month and 2 month postoperatively) in 2 groups

	In Group 1, p-values^* from comparison of each values between			In Group 2, p-values^† from comparison of each values between
	Preop and POD#1Mo	POD#1Mo. and POD#2Mo	Preop and POD#2Mo	Preop and POD#1Mo	POD#1Mo. and POD#2Mo	Preop and POD#2Mo
CRSE	0.018	0.175	0.018	<0.001	0.021	<0.001
MRSE	0.018	0.018	0.018	<0.001	<0.001	<0.001
CRSE-MRSE	0.018	0.018	0.078	0.282	0.216	0.028

Preop = preoperative period; POD#1Mo. = 1 month postoperatively; POD#2Mo. = 2 months postoperatively.

CRSE = cycloplegic refraction spherical equivalent; MRSE = manifested refraction spherical equivalent.

^* Wilcoxon signed rank test

^† Paired t-test.

Table 6.

Comparison of UCVA, BCVA between 2 groups

	UCVA			BCVA
	Group 1	Group 2	p-value^*	Group 1	Group 2	p-value^*
Preop	0.99 ± 0.38	0.95 ± 0.31	0.672	0 ± 0	0 ± 0	1.000
POD#1Month	0.06 ± 0.10	0.03 ± 0.07	0.672	0 ± 0	0.001 ± 0.01	0.906
POD#2Months	0.03 ± 0.08	0.01 ± 0.04	0.879	0 ± 0	0.001 ± 0.01	0.906

Values are presented as mean ± SD.

UCVA = uncorrected visual acuity; BCVA = best corrected visual acuity.

^* p < 0.05 by Mann Whitney test was considered to be statistically significant.

Table 7.

Changes of MRSE and CRSE-MRSE of 7 eyes in group 1

	Sex/age	MRSE				CRSE-MRSE
	Sex/age	Preop	POD#1Month	POD#2Months	POD#4Months	Preop	POD#1Month	POD#2Months
Case#1	F/19	-8.25	-3.125	-1.25	-2.75	0.75	1.875	0.75
Case#2	M/18	-4.5	-1.875	-1.125	-0.875	0	2	0.625
Case#3	M/18	-4	-0.75	-0.5	-0.75	0	1.375	0.25
Case#4	M/24	-4.5	-0.75	-0.625	-0.625	0.25	0.375	0.125
Case#5	F/22	-1.75	-0.375	-0.25	0.25	0.75	1.625	1.375
Case#6	M/24	-2.5	-0.375	0.125	0.25	-0.25	1.375	0.625
Case#7	M/19	-8.625	-0.375	0	Missing	-0.25	0.375	-0.25

MRSE = manifested refraction spherical equivalent; CRSE-MRSE = cycloplegic refraction spherical equivalent-manifested refraction spherical equivalent.

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