Laser In Situ Keratomileusis for Hyperopia

I would like to comment on Buzard and Fundingsland's article on laser in situ keratomileusis (LASIK) for hyperopia.1 The group of patients in this study included 1 who had “congenital hypermetropia” and the rest had a variety of refractive procedures: radial keratometry, automated lamellar keratoplasty, penetrating keratoplasty, and LASIK. This makes it a totally heterogeneous group, and we know that the nomograms are different in each of these situations. Therefore, it is not possible to draw conclusions. The preoperative hyperopia was too low (+1.49 ± 0.80 diopters [D]) to draw postoperative conclusions (5 of the 14 patients had a preoperative visual acuity of 20/40 or better). Ruiz used masks to treat hyperopia, as stated by the authors, but (I believe) he later abandoned this technique because of unsatisfactory results. The authors said they used a 6.0 mm optical zone, but this is incorrect. They actually used an optical zone of 3.5 mm because this is the size of the piece of contact lens used to block the laser. A 3.5 mm optical zone is too small to be used in the treatment of hyperopia. This method cannot be used to treat astigmatism (9 of the 14 patients had more than 1.0 D of astigmatism). The authors say, “The edges of the central elevation were gently scraped with the back of a Paufique corneal knife to remove any elevated edge …” However, this is an imprecise technique and is not in line with current laser methods. Finally, I have published a paper on hyperopic LASIK2 using the latest scanning laser technology in a group of 679 patients with an optical zone between 5.0 and 5.5 mm and the capability of treating astigmatism. Carlos Argento MD aBuenos Aires, Argentina