Presbyopia Correction Surgery – Eliminate Reading Glasses
Presbyopia correction surgery is used to correct for the normal age-related loss of near focusing ability that affects people over age 40.
Types of presbyopia-correcting surgery include laser procedures, such as LASIK and PRK, and lens-based procedures like refractive cataract surgery and refractive lens exchange. Other options include conductive keratoplasty (CK) and corneal inlays.
Some of these procedures intentionally correct one eye for distance vision and the other for near vision—a type of vision correction called monovision. Others produce a multifocal effect, designed so both eyes can see equally well both far away and up close.
Monovision LASIK
Monovision LASIK is similar to monovision produced with standard (single vision) contact lenses. In both cases, one eye is prescribed a lens power (or laser treatment) to provide clear distance vision, and the other eye is treated to provide acceptable near vision.
Generally, people who can adapt to monovision contact lenses can also adapt to monovision LASIK. Most surgeons prefer that people considering monovision LASIK first try monovision with contact lenses for a period of time to make sure they are satisfied with monovision and function well with this mode of vision correction.
Though monovision adequately corrects presbyopia for most people who try it, there are some compromises. Some people find correcting one eye for near makes their binocular distance vision unacceptably blurred, especially when driving at night or performing other tasks in low-light conditions. Others may find that monovision doesn't offer enough magnification for reading relatively small print.
For these reasons, it is best to try monovision with contacts before committing to more permanent monovision with LASIK.
In July 2007, Advanced Medical Optics (AMO) became the first surgical equipment manufacturer to receive FDA approval for an excimer laser platform to provide monovision LASIK surgery in the United States.
Monovision LASIK can be performed as part of a standard LASIK procedure or a custom LASIK procedure.
Multifocal LASIK
Multifocal LASIK works on the same principle as multifocal contact lenses. Multiple zones of different power are created on the cornea to provide good vision at all viewing distances.
Multifocal LASIK offers a couple advantages over multifocal contact lenses: It eliminates the need for daily contact lens care and the ongoing expenses of purchasing replacement contact lenses and lens care solutions.
Also, multifocal LASIK may provide more stable comfort and vision, since there is no worry about contact lenses drying out on the eye or becoming less clear due to an accumulation of protein deposits or other debris on the surface of the lenses.
The terms multifocal LASIK and PresbyLASIK are often used interchangeably.
[Read more about multifocal LASIK]
Refractive Cataract Surgery
Refractive cataract surgery is the term used to describe modern cataract surgery where the goal is to reduce a person's need for corrective eyeglasses after cataracts are removed.
In the past, most people who had cataract surgery had some nearsightedness, farsightedness or astigmatism remaining after the procedure. And because traditional intraocular lenses (IOLs) were monofocal lenses, nearly everyone had symptoms of presbyopia after cataract surgery and therefore needed reading glasses.
Today, people want to be as free from glasses as possible after cataract surgery, and with the use of premium lens implants such as accommodating IOLs and multifocal IOLs, there has been a merging of cataract surgery and refractive surgery into a single procedure.
[Read more about refractive cataract surgery.]
Refractive Lens Exchange (RLE)
Refractive lens exchange (RLE) is virtually the same as cataract surgery, but instead of removing a cloudy lens, the surgeon removes the lens from the eye when it is still clear. RLE is also called clear lens extraction, clear lens exchange, or CLE.
Refractive lens exchange was originally developed to correct large amounts of nearsightedness using traditional monofocal intraocular lenses. But with the development of accommodating IOLs and multifocal IOLs, RLE now can correct presbyopia as well.
[Read more about refractive lens exchange.]
Conductive Keratoplasty
Like LASIK and PRK, conductive keratoplasty (CK) is a corneal refractive surgery that affects only the front surface of the eye. But CK doesn't remove any corneal tissue with an excimer laser. Instead, the surgeon uses a small hand-held probe to deliver low-level, radio-frequency (RF) energy to specific spots in the periphery of the cornea.
The RF energy shrinks the corneal tissue (called collagen) in these spots, causing the central cornea to steepen in curvature, which gives the eye more magnifying power for near vision.
Conductive keratoplasty used to correct presbyopia is also called NearVision CK. The procedure is performed on one eye only to create a monovision correction.
[Read more about conductive keratoplasty.]
Other Presbyopia Correction Surgery
The field of presbyopia correction surgery is rapidly changing, and several new procedures are in development or in clinical trials.
One promising procedure is the implantation of small optical devices called corneal inlays under the surface of the cornea. The inlays increase depth of focus to improve near vision without significantly interfering with distance vision, according to proponents.
Other presbyopia-correcting surgical procedures in development include methods to restore flexibility to the eye's natural lens and new flexible intraocular lenses that may be able to restore the eye's near focusing ability.
Last updated: February, 2010
