We appreciate the comments of García-González and Teus on our article. In the study cohort, less than 17% of the patients were dissatisfied with the outcome. It is to be noticed that the Parinaud (p) scale is a measurement at 33 cm (not at 35 cm as in Jaeger tests or 40 cm as in Radner tests), and p3 corresponds to an equivalent logarithm of the minimum angle of resolution of 0.1, which approximates the Jaeger 2 (revised scale) at 35 cm and the Radner 0.1 logarithm of the reading acuity determination at 40 cm.
Also, the values of uncorrected distance visual acuity (UDVA) of 20/32 were measured at 6 m (not at 4 m, as most papers report). Concerning postoperative UDVA compared to preoperative corrected distance visual acuity, ± 1 line is the day-to-day variation in measurements of visual acuity (for that reason, the 2 lines level the relevant benchmark for gain or loss of corrected visual acuity); and the residual myopia (as well as any residual astigmatism) accounts for the other line.
The retreatment rate of 20% is in line with other types of presbyopic corrections, including monovision. Further, the retreatment rate in the best monovision series cannot be better than in regular refractive surgery (which sets the potential lowest level of retreatment after multifocal or monovision ablations).
The visual results after PresbyMAX (Schwind Eye-Tech-Solutions, Kleinostheim, Germany) enhancement (not provided in the article), both in the cases that had residual refraction (with the target of achieving emmetropia, keeping the multifocal profile) and in patients intolerant to multifocality and wishing to have a monofocal cornea again were good in reaching a binocularly mean post-retreatment UDVA of 20/25 or better combined with mean post-retreatment uncorrected near visual acuity (UNVA) of p3 (except for the reversal cases, decreasing to a mean post-retreatment UNVA of p5).
Our setting monovision patients obtained similar or even better visual results than the patients treated using PresbyMAX, but even before surgery, the patient cohorts were different (eg, mean age, 53 ± 6 years for PresbyMAX compared to 47 ± 4 years for monovision or a required addition 2.03 ± 0.45 diopters for PresbyMAX compared to 1.50 ± 0.30 diopters for monovision). Differences may be noted, but they are affected strongly by the varying cohorts. The better UNVA after monovision for these cases can be explained by the ages of the patients as well as by their required addition of near vision, both related to a higher amount of residual accommodation in the monovision cohort. The better UDVA after monovision can be explained by the monofocal nature of the monovision treatments.
We agree that further investigation is needed to improve our knowledge about the real advantages and disadvantages of the differing procedures currently available for the treatment of presbyopia, including their reversibility.