Everything you want to know about laser presbyopia correction and the PresbyMAX method, but are afraid to ask

Corneal ablation technique PresbyMAX (bi-aspheric multifocal corneal ablation) was developed by J. Alio in 2006 and involved modeling the central field of a steep aspheric cornea. The method was launched in 2009. This maximally individualized profile of laser vision correction for presbyopia with or without co-occurring visual defects (range from – 7.0 diopters to +3 diopters and up to 4.0 cylinders) is today the least invasive method of presbyopia treatment and results in the fewest possible complications.

PresbyMAX assumes symmetrical participation of both eyes in near and far vision and a split of near, intermediate distance and far visual activity of respectively: 35%, 15% i 50%.

There is a kind of islet in the central part of the cornea. This central part of the cornea is responsible for sharp near vision, while the peripheral part of the cornea allows for sharp distance vision. During the PresbyMAX procedure, the cornea is modeled with a laser so that its new curvature allows the patient to see from different distances. The central portion of the cornea allows for near vision, while the peripheral portion facilitates intermediate and distant vision.

Schwind Amaris excimer laser is used for the procedures. This laser has special algorithms that allow us to precisely correct the visual defect based on the width of the patient’s pupil. Schwind AMARIS 1050 RS is a premium ophthalmic laser among excimer lasers for refractive surgery. It has an extremely fast 7D seven-dimensional eye tracking system with a video camera that monitors eye movement without time delay during lasering .

PresbyMAX treatment is performed exclusively with the method of FemtoLASIK.

One of the conditions for undergoing PresbyMAX is that the patient’s own lens be translucent. This means that if the doctor notices even the slightest clouding of the lens, heralding the beginnings of cataracts, he will not perform the PresbyMAX procedure, and then refractive lens replacement or cataract surgery with modern implants to enable continued reading is recommended. If the choice is a multifocal lens (trifocal, multifocal or EDOF), it will enable very good visual acuity for distance, near (35-40 cm) and intermediate distance (60-90 cm).

The PresbyMAX method is available in three variants, which differ only in the depth of field in the dominant eye – i.e., the eye with which we mainly look away.

• PresbyMAX μ-Monovision produces the same depth of field in both eyes, with one eye optimized for distance and the other eye optimized for near. This procedure focuses on good near and intermediate vision for both eyes.
• PresbyMAX Hybrid uses the same target values as for μ monovision, but a different depth of field is generated in the dominant and non-dominant eye. Patients get used to this visual sensation very quickly and benefit from good vision at all distances.
• PresbyMAX Monocular has no depth of field in the dominant eye, the non-dominant eye receives the same depth of field as with other PresbyMAX methods. This makes the quality of distance vision particularly good.

In order to undergo the PresbyMax procedure, the patient must have a translucent native lens. This means that if the doctor notices even the slightest clouding of the lens in a patient, heralding the onset of cataracts, before treating presbyopia (and possible refractive error), he or she will first coordinate refractive lens replacement or cataract surgery with modern implants for continued reading.

In addition to cataracts, contraindications to the PresbyMAX procedure include:

• Glaucoma, inflammation of the eye, cone, dystrophies and other corneal abnormalities
• autoimmune (autoimmune) diseases
• endocrine disruptors
• unfavorable optical parameters of the eye such as thin cornea, too wide pupils, too steep or flat corneal curvature, severe dry eye syndrome

For optimal treatment results, the procedure must be performed in both eyes. In a few cases, patients have to use small positive power nearsighted glasses after the procedure in low light conditions. J

Since different factors affect the effect of the correction in each individual case, the PresbyMAX treatment can be repeated after at least 6 months if necessary. Doctored is equally minimally invasive and safe.