All laser lasik treatments
Various compensatory techniques for presbyopia are possible. They all have specific characteristics in terms of indications and outcomes. After a thorough assessment and explanation of the proposed techniques, you will choose, along with your surgeon, the best solution for your specific case. As always in lasik, both eyes are operated on the same day, one after the other.
The main presbylasik techniques are the following:
Presbylasik using monovision:
It is a very efficient technique which may be reversible. It has been well known for many years both in refractive surgery and by contact lens wearers.It requires good vision in both eyes. Broadly speaking, the proposed treatment will be different in both eyes. Distance vision will be obtained in the dominant eye and near vision in the other.
Distance vision is obtained by correcting totally the distance refractive disorder specifically in the dominant eye.
Near vision is obtained by adapting the refractive correction of the dominant eye in different ways depending on the initial defect: a low degree of myopia can be left in the myopic eye or induced in the hyperopic and emmetropic eye. The combination of asphericity changes improves the depth of field for better near vision.
The difference of vision between the two eyes is always moderate and is tested before surgery.
It is rarely perceived in everyday life and is generally very well tolerated, otherwise the following technique can be considered
Presbylasik using aspherical micromonovision:
This technique focuses on the depth of field relative to a spherical addition.
The final refraction is very similar of both eyes, even if one performs better for distance and the other for near vision. The more similar the final refraction between both eyes is, the less the patient will need correction lens for near vision, which makes sense.
The spherical aberration rate is changed so as to get the best far/near compromise. These spherical aberrations cause a change in refraction based on the size of the pupil since the cornea becomes multifocal.
Indications and limitations of Presbylasik:
It is difficult to establish a predefined decision tree stating what techniques are most indicated. In fact, there are multiple parameters to be taken into account. They range from the initial refractive disorder associated to presbyopia (myopia, hyperopia, astigmatism) to the expectations of the patient depending on their professional and personal activities, age, the biometric powers of the eye, pupillary reactivity...
Overall however, the outcomes are excellent: in the hyperopic patient, by inducing efficient corneal multifocality, in the myopic patient, by inducing a slight under-correction in the dominated eye and in the emmetropic patient, by treating mainly the dominated eye.
Intermediate vision for screen work is a winner in these techniques.
Recovery is generally very fast for near vision. However, in the event of induction of strong asphericity modifications, recovery in distance vision can take a few weeks to be complete.
Of course, presbylasik is offered only to patients who eyes who do not have any pre-existent retinal pathology or cataract. A retinal examination by OCT can confirm the retinal anatomy and the OQAS (Optical Quality Analyzing System) test gives the refractive index of the media.
When lens opacity is observed, an early sign of cataract, intra ocular surgery with multifocal implants is proposed from the outset.
If a cataract develops later on in an eye previously operated with presbylasik, there are no changes or specific complications in the surgical technique to use, but the type of presbylasik previously used must be considered to determine and calculate of the power of the implant.
Multifocal Intra Ocular Lens (IOL)
This surgical technique is very efficient and well tested through years of so-called "Premium" cataract surgery.
It can be proposed to patients from 55/60 years of age, all the more so as their lens loses transparency. The surgery consists in the extraction of this lens, which is replaced with a multifocal intra ocular implant (IOL). The patient will not develop a "cataract" later since their natural lens has been removed.
Surgery takes place in two stages, a few days apart, unlike presbylasik that allows treatment of both eyes on the same day in the same session.
In general, both eyes will have the same postoperative vision.
All visual defects can be managed with these multifocal IOL. Their power is calculated after optical biometry. It is suitable for myopia, hyperopia, astigmatism, but also for emmetropia, i.e. people who need correction only for near vision. However, in very severe cases of ametropia, the surgeon may need to offer an alternative solution.
For this clear lens surgery, the eye should have no retinal or optic nerve disease. Complications are rare and are the same as for standard cataract surgery, performed in 700,000 people each year in France.
There are multiple choices for implants. They can be bifocal, trifocal or toric lens implants. They can be refractive or diffractive, focused on distance, intermediate or near vision.
Each has its advantages and disadvantages. Balancing out the pros and cons helps choose which implant will best meet your needs.
Please note that the main disadvantages are the possible perception of some night halos and the need for adequate lighting conditions to get optimal near vision.
Management of presbyopia with new implants is very efficient and has been a very widely developed.