Laser vision correction and other surgeries for presbyopia
10 Dec 2021
From what age and when it is recommended to undergo laser vision correction for presbyopia?By getting elder the lens of the eye loses its elasticity, which makes it difficult to focus vision at close range. At the same time, a person cannot see the fine print or small objects. All older people are at risk of presbyopia, mostly from 45 years of age. Clinical research and patient demand has resulted in more and more individualized treatments for presbyopia in recent years 1 2 3 4 5. Presbyopic corneal correction techniques (not intraocular lenses) can be categorized as 6 7:
- laser multifocal vision correction,
- intracorneal multifocality,
- corneal segments (implants).
How is the Presby-LASIK surgery type done ?The essence of all laser refractive surgery for presbyopia is multifocal ablation, i.e. based on the creation of two or more areas of different optical power in which the greatest visual acuity is achieved. This can be achieved by creating different cornea curvatures for distance visual acuity and near reading in different eyes (monovision) or in one eye. In monovision, the dominant eye is usually corrected for distance. In the second case, basically, a small central optical region is created with a steeper curvature for reading and a less steep region for distance vision (see Fig. below). The number of areas can be more than 2. Here visual acuity depends on the size of the pupil 8,9. It is necessary to understand that each person has a dominant eye, which is operated so that the distance visual acuity is maximum on it. One such ablation profile for presbyopic patients has been performed with AMARIS lasers since 2007.
One such module for Presby-LASIK with two areas of vision is PresbyMAX® of three surgeries (µ-Monovision, Hybrid, Monocular), which differ in the degree of difference in refraction between the eyes (anisometropia). There are other multifocal surgeries of this type from other manufacturers of surgeries with commercial names such as Presbyond®, Supracor ™ and CustomVue ™ VISX, however in the case of Presbyond® the central cornea is left for distance vision 10. It should be understood that a high degree of anisometropia can lead to loss of stereoscopic (spatial) vision and contrast sensitivity. Here we can add that such operations with Presby-PRK or Presby-LASEK are rare, because there is a possibility that multifocality on the cornea may be partially covered by the processes of overgrowing of the removed epithelium (re-epithelialization). Hence, the presence of a flap excludes this possibility.
Other surgery types to correct presbyopiaRecently, IOL implantation has been chosen by an increasing number of refractive surgeons and patients due to its reversibility and a wider range of vision error correction. IOLs are considered to be more accurate and safer than laser presbyopia 11, but laser vision correction is worth considering as well. Patients undergoing posterior IOL surgery should be counseled about the risk of cataracts and the potential need for further surgery 11. Surgeons and patients should make decisions carefully according to specific situations 12. There are the following most popular alternative treatments for presbyopia:
- Reading glasses
- Progressive glasses
- Contact lenses
- Monofocal vision with Presby-LASIK or by replacing the lens of the eye with an intraocular lens (IOL)
- Monovision with Presby-LASIK
- Monovision when replacing the eye lens by an IOL
- Multifocal methods for Presby-LASIK and IOL
- Corneal segments (implants)
- Conductive keratoplasty
Results after laser vision correction of prebiopiaLet's consider clinical results after applying PresbyMAX® technique and its three modes: monocular, hybrid and µ-monovision. They differ from each other in the magnitude of refraction into the distance and must be selected individually. We will not delve into the theory, but compare the results of recent positive studies. The results of clinics in Holland in 2020 showed that even 6 years after surgery, presbyopic treatment using hybrid and µ-monovision modes is safe and effective. Postoperative results indicate improved binocular vision for distance, near, and mid-range. To improve patient satisfaction, 8% of patients had to resort to a second course of surgery 9. Binocular Uncorrected Distance Visual Acuity (BUDVA, i.e. by two eyes)> 20/20, or one (0 according to the logMAR table), was achieved in 100% of patients. Although individually 16% of the eyes lost more than 2 lines of visual acuity compared to vision with glasses before surgery, no line was lost in the case of binocular vision after 6 years. One of the latest studies 8 of the same 2020 of the same PresbyMAX® technique for patients from 42 to 62 years old in the People's Republic of China, but a monocular mode, has shown its safety and efficacy for correcting presbyopia and that it can improve vision both at far and near distance. However, deterioration in the quality of vision can occur at an early stage, but gradually recover to the preoperative level. All patients had binocular vision (vision with two eyes) more than 100% at a distance of more than 100% after 12 months (≥ 20/20 according to Snellen chart or ≤ 0.0 according to the logMAR table, or more than 10 lines according to the Sivtsev’s table). Binocular near visual acuity of more than 100% was achieved in almost 78% of patients. Preservation of visual acuity after eye correction remained at a high level, because no one has lost more than 2 lines. The PresbyMAX® monocular mode in study 13 of the same year 2020 showed that it can provide a quick recovery of vision, and therefore is recommended for people with increased demands for distance vision. Patients over 40 years old showed stable refraction during the following 2 years. Binocular uncorrected distance visual acuity (BUDVA) remained ≥ 20/25 or 80% (0.1 acc. the logMAR table), and binocular uncorrected near visual acuity (for reading) (BUNVA) > 20/25 remained in 90.9% of patients. Here, too, none of the patients lost more than 2 lines of visual acuity compared to visual acuity with glasses before the operation. The study results 14 of 2019 from clinic in Spain using one of the currently popular PresbyMAX® modes (µ-Monovision) showed a good stability of eye refraction after three months and three years (deviation 0.25 D). There is also a less successful study 15 of patients over 40 years old after one year using PresbyMAX® technology (µ-Monovision and Hybrid) from Germany, dating back to 2020. Although the indicators of the achieved refraction remained quite high, i.e. a change of no more than 1 diopter was in 89% of the eyes in the dominant eye (reading vision), and 86% in the dominant eye (distance vision), but about 31% of patients lost more than 2 lines of visual acuity compared to vision with glasses before surgery. However, the Hybrid and µ-Monovision methods with PresbyMAX® technology in 2020 showed higher results 16 after 1 year in patients from 41 to 51 years old in China. So in 99% of patients, the change in refraction was less than 1 diopter. None of the patients lost more than 2 lines of visual acuity compared to vision with glasses before surgery. There are also results of studies from Russia after 4 years using the µ-Monovision mode in patients aged from 40 to 59, presented at an international congress in 2019 17. It was shown that the average binocular visual acuity significantly improves after surgery, stabilizes within 6 months after surgery and remains stable for at least 4 years of the follow-up. As it has already become clear, monocular surgery with PresbyMAX® has an advantage over classical monovision in that it uses intermediate vision in the non-dominant eye and restoration of distance vision is usually achieved after about 3 months. By other PresbyMAX® modes this period is even faster.
Prospects for treating presbyopiaImplantation of a refractive lenticule can be an effective alternative to the treatment of presbyopia or to eliminate complications of LASIK 18. Despite the leading development of materials with increased biocompatibility with the cornea, the implantation of natural donor tissue, that is a refractive lenticule, can provide better diffusion of nutrients through the cornea than presbyopic inserts (implants). Implantation of the lenticule can provide an inexpensive alternative to synthetic material that is associated with subsequent opacification, fibrosis (proliferation of connective tissue), or abnormal corneal shape 18. After natural tissue implantation, the corneal shape remains more natural compared to laser treatment.
Attention! If you have more recent information, we will be happy to accept it. If you have any questions, put it on the forum (https://findsurgery.eu/forum/) or ask directly by email firstname.lastname@example.org. Bibliography
- Uthoff D, Pölzl M, Hepper D, Holland D. A new method of cornea modulation with excimer laser for simultaneous correction of presbyopia and ametropia. Graefe’s Arch Clin Exp Ophthalmol. 2012;250(11):1649-1661. doi:10.1007/s00417-012-1948-1
- P B, F P, S. AM. Uncorrected binocular performance after biaspheric ablation profile (PresbyMAX) for presbyopic corneal treatment. Am J Ophthalmol. 2013. doi:10.1016/j.ajo.2013.07.005
- Luger MHA, Ewering T, Arba-Mosquera S. One-year experience in presbyopia correction with biaspheric multifocal central presbyopia laser in situ keratomileusis. Cornea. 2013;32(5):644-652. doi:10.1097/ICO.0b013e31825f02f5
- Luger MHA, Ewering T, Arba-Mosquera S. 3-Month experience in presbyopic correction with bi-aspheric multifocal central presbyLASIK treatments for hyperopia and myopia with or without astigmatism. J Optom. 2012;5(1):9-23. doi:10.1016/j.optom.2011.12.001
- Iribarne Y, Juárez E, Orbegozo J, Saiz Á, Mosquera SA. Bi-aspheric ablation profile for presbyopic hyperopic corneal treatments using AMARIS with PresbyMAX module : Multicentric Study in Spain. 2012:5-16.
- Arba Mosquera S, Alió JL. Presbyopic correction on the cornea. Eye Vis (London, England). 2014;1:5. doi:10.1186/s40662-014-0005-z
- Higginbotham J. Correcting Presbyopia – Modern Options Head of Clinical Affairs What is Presbyopia ? Birmingham Opt. 2016:44. https://de.slideshare.net/JasonHigginbotham/correcting-presbyopia-modern-options.
- Fu D, Zhao J, Zhou X-T. Objective optical quality and visual outcomes after the PresbyMAX monocular ablation profile. Int J Ophthalmol. 2020;13(7):1060-1065. doi:10.18240/ijo.2020.07.07
- Luger MHA, McAlinden C, Buckhurst PJ, Wolffsohn JS, Verma S, Arba-Mosquera S. Long-term outcomes after LASIK using a hybrid bi-aspheric micro-monovision ablation profile for presbyopia correction. J Refract Surg. 2020;36(2):89-96. doi:10.3928/1081597X-20200102-01
- Sinjab MM, Cummings AB. Customized Laser Vision Correction. Springer International Publishing AG; 2018. doi:10.1007%2F978-3-319-72263-4
- Barsam A, Allan BD. Excimer laser refractive surgery versus phakic intraocular lenses for the correction of moderate to high myopia. Cochrane Database Syst Rev. 2012;(5):CD007679. doi:10.1002/14651858.CD007679.pub2
- Chen H, Liu Y, Niu G, Ma J. Excimer Laser Versus Phakic Intraocular Lenses for Myopia and Astigmatism: A Meta-Analysis of Randomized Controlled Trials. Eye Contact Lens. 2018;44(3):137-143. doi:10.1097/ICL.0000000000000327
- Fu D, Zhao J, Zeng L, Zhou X. One Year Outcome and Satisfaction of Presbyopia Correction Using the PresbyMAX® Monocular Ablation Profile. Front Med. 2020;7(November):1-8. doi:10.3389/fmed.2020.589275
- Villanueva A, Vargas V, Mas D, Torky M, Alió JL. Long-term corneal multifocal stability following a presbyLASIK technique analysed by a light propagation algorithm. Clin Exp Optom. 2019;102(5):496-500. doi:10.1111/cxo.12883
- Kohnen T, Myriam B, Herzog M, Hemkeppler E. Near visual acuity and patient-reported outcomes in presbyopic patients after bilateral multifocal aspheric laser in situ keratomileusis excimer laser surgery. J Cataract Refract Surg. 2020;46:944-952.
- Liu F, Zhang T, Liu Q. One year results of presbyLASIK using hybrid bi-aspheric micro-monovision ablation profile in correction of presbyopia and myopic astigmatism. Int J Ophthalmol. 2020;13(2):271-277. doi:10.18240/ijo.2020.02.11
- Eskina EN. CORRECTING PRESBYOPIA USING BI-ASPHERIC MULTIFOCAL ABLATION PROFILE RELATED TO THIS PRESENTATION. ESCRS 2019, Paris. 2019.
- Lazaridis A, Messerschmidt-Roth A, Sekundo W, Schulze S. Refractive lenticule implantation for correction of Ametropia: Case reports and literature review. Klin Monbl Augenheilkd. 2017;234(1):77-89. doi:10.1055/s-0042-117280