Presbyopia and surgery

How should optometrists tackle presbyopia solutions with patients, ask Georgina Wintersgill and Kieran Loft MCOptom.

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Surgery to correct ametropia has traditionally been performed in three ways: on the cornea, within the cornea, or in the lens capsule. For presbyopic patients aiming for spectacle independence, there are three main options: (modified) monovision, multifocal (MF) or accommodation-restoring techniques.

Conductive keratoplasty and laser eye surgery are performed on the cornea. Laser eye surgery includes laser-assisted in situ keratomileusis (Lasik), small incision lenticule extraction (SMILE), and surface laser treatments such as laser-assisted subepithelial keratectomy (Lasek) and photorefractive keratectomy (PRK). Using laser to create an ‘MF corneal profile’ is a possible treatment paradigm for presbyopia, sometimes referred to as PresbyLasik. Different versions of this treatment show different levels of success, and long-term outcomes are still being collated (Vargas-Fragoso and Alio, 2017; Gil-Cazorla et al, 2016).


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