PresbyLASIK is an advanced form of LASIK surgery, where an ultraviolet laser reshapes the cornea to create unique “zones” of vision. From these zones, the brain can better process visual information that is up close, a medium distance away, and a long distance away.

Depending on how the age-related loss of vision affects the patient, the cornea can be reshaped in different ways to compensate for the vision loss.

PresbyLASIK is usually a quick procedure with minimal recovery time. Side effects are comparable to those of standard LASIK treatments. Patients can request a reversal if the results are not to their liking.

What Is PresbyLASIK?

woman undergoing lasik procedure

PresbyLASIK is an advanced laser vision correction procedure (surgery) that makes changes to the shape of the cornea in the eye, in order to create zones of different vision power to help a person see at different distances.

PresbyLASIK is also known by a few other names, such as multifocal LASIK and laser presbyopia surgery. It is used to correct presbyopia, the condition of the eye’s natural lens losing its flexibility as a person gets older. Presbyopia causes close-up vision to become blurry and unfocused.

Like progressive lenses and multifocal eyeglasses, PresbyLASIK is intended to correct presbyopia. Presbyopia can develop in patients who have had perfect vision all their lives.

How does presbyLASIK help presbyopia? During the procedure, an excimer laser (an ultraviolet laser that is used in the creation of microelectronics, integrated circuit chipboards, and eye surgery) carefully cuts and reshapes the cornea, creating different zones for close-up vision, intermediate vision, and long-distance vision. The zones can be no more than a few millimeters in size.

The patient’s brain will select which zone it needs to use to see with the most clarity. This depends on the distance of the object requiring focus.

In each zone created by the surgery, light is refracted (bent) differently, which gives people who have presbyopia the ability to regain functional vision at all distances.

It is a similar concept to how multifocal lenses are used to help the eyes as they age, and the lens loses its flexibility to focus on its own. The problem with multifocal contact lenses is that, as the rest on the surface of the eye, they can become displaced and distort the very vision they were supposed to correct. With presbyLASIK, however, the augmented zones are directly on the eye’s surface. They are stationary and fixed, so no amount of movement of the eyes will change their effects.

Costs & Expectations

PresbyLASIK is a relatively quick procedure with a fast recovery time. For the most part, there is no pain or discomfort associated with receiving this procedure. In terms of affordability, it tends to cost around $2,000 per eye, and most clinics will offer some form of financial assistance for the operation.

To receive presbyLASIK, patients must be diagnosed with presbyopia and meet the other criteria that are used in the treatment of other vision correction procedures that require standard LASIK surgery. This includes:

  • Being over 21 years of age.
  • Having otherwise stable vision.
  • Having no history of eye disease.

Patients should be given realistic expectations of the limitations of presbyLASIK. For example, if a patient has had surgery that involved the insertion of an artificial lens (like a refractive lens exchange), then they will likely not be eligible to receive presbyLASIK surgery.

Types of Laser Presbyopia Correction

laser eye surgery

Much like how progressive eyeglasses and multifocal contact lenses can be designed in different ways, there are a few distinct presbyLASIK procedures that can reshape the cornea in different ways to offer patients the best correction for their presbyopia.

For example, some patients will receive the greatest benefit when their presbyLASIK is carried out in the central zone, to give them the best distance vision. If the process needs to be reversed (giving the patient pure monofocal distance correction), the reshaping in the central zone can be easily undone.

On the other hand, some optometrists might go with presbyLASIK with close-up vision in the central zone, with the peripheral zone providing improved distance vision. This option helps the surgeon give the patient a stronger correction for reading and other tasks that have to be performed with near vision. Additionally, the near-center option tends to cause fewer unexpected effects than the reshaping performed at the distance-center point.

In most cases, the type of LASIK for presbyopia that a patient will qualify for will be based on the kind of refractive error that needs correcting. For patients with nearsightedness and presbyopia, a distance-centered multifocal LASIK operation may be the best option for them. Conversely, someone whose presbyopia causes farsightedness may benefit more from a near-centered multifocal LASIK design.

For this reason, it is vital to receive a full consultation and evaluation with an eye surgeon. You will discuss specific needs based on refractive error and vision problems before making any decisions on what kind of presbyLASIK procedure to receive.

Modified Monovision

Modified monovision is another kind of presbyLASIK procedure, where the corneal reshaping is done in one eye, and a normal LASIK procedure is performed in the other. Modified monovision can help some people with their distance vision for driving, but it might also require them to use reading glasses more often. This procedure can also lead to a minor loss in depth perception.

The good thing about modified monovision is that patients’ eyes can easily be tested for compatibility. Regular monovision normally provides only a near and far focal point, and modified monovision with multifocal LASIK offers a third, middle focal point. This intermediate point is not possible to have with monovision.

The benefit of this is that it allows patients to be able to see over a wide range of distances.

PresbyLASIK can be reversed. If a patient decides that their new vision is not a good fit for them, they can opt to receive a LASIK enhancement procedure to offer a full correction, but they will likely have to continue to use corrective lenses. For example, a patient who does not like their driving vision after receiving presbyLASIK can get standard LASIK to experience full distance vision, but they will struggle to process near vision without glasses.

Effectiveness & Side Effects

Is presbyLASIK effective? Most patients have 20/20 or 20/25 distance vision. They can enjoy reading books and newspapers, without the need of glasses.

Patients who had normal vision except for presbyopia before the intervention of multifocal LASIK might experience blurry distance vision immediately after the surgery. There is a chance that this problem will continue. Some patients may also experience reduced contrast sensitivity (the ability to distinguish between increasingly finer increments of light and dark, especially against backgrounds of similar colors) or a greater likelihood of seeing halos around lights in dark conditions.

It is possible that the loss of contrast sensitivity brought on by the presbyLASIK procedure will only be temporary. Some doctors report that these effects will disappear upward of six months after the operation.

Patients who develop cataracts after their presbyLASIK can still get surgery to remove the cataracts. However, the corneal reshaping that comes with the multifocal LASIK surgery will make it difficult for the cataract surgeon to determine the appropriate power for the intraocular lens that should give the patient improved vision after the cataract surgery. It might be necessary for the patient to wear glasses after the cataract surgery, or they may require further corneal refractive surgery to restore their vision to the point where they will not need corrective glasses for driving, reading, or other visual tasks.

There is no guarantee that the results of the presbyLASIK procedure will be permanent. It is possible that, as the eyes continue to get older, the cornea will require further reshaping with other forms of LASIK surgery. A very small number of patients could potentially struggle to see as well as they were able to before the operation, even if they use glasses or contact lenses after the operation.

The best way to know if presbyLASIK is the right option is to schedule a complete eye evaluation and exam with a doctor. There, you can discuss all possible concerns and options for improving your vision.

 

References

What Is Presbyopia? (January 2020). American Academy of Ophthalmology.

Presbyopia Treatment. (January 2020). American Academy of Ophthalmology.

Medical Definition of Excimer Laser. (December 11, 2018). MedicineNET.

Presbyopia. Kaiser Permanente.

5 Tips For Multifocal Contact Lens Success. (February 9, 2016). American Optometric Association.

A Novel Laser Refractive Surgical Treatment for Presbyopia: Optics-Based Customization for Improved Clinical Outcome. (June 2017). Sensors (Basel).

Modified Monovision Yields Better Intermediate, Distance Visual Acuity. (November 2014). Healio.

Laser Presbyopia Reversal: An Alternative Procedure. (January 2007). CRST Europe.

Pros and Cons of LASIK: Are the Risks Worth the Cost? (December 2017). Michigan Health.

Contrast Sensitivity. Science Direct.

Effectiveness Of Multifocal Intraocular Lenses To Correct Presbyopia After Cataract Surgery: A Randomized Controlled Trial. (October 2004). Ophthalmology.

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