Presbyopia and surgery

30 November 2018
Autumn 2018

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

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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