What is laser correction of presbyopia

Presbyopia also known as presbyopia, is not a visual defect, but a set of physiological changes that occur with age in the human eye. It is estimated that nearly 10 million Poles struggle with presbyopia, completely unaware of it and treating trouble reading fine print as something natural.

The flexibility of the lens decreases with age, and its ability to change refractive power also decreases. This process begins very early. If it becomes noticeable after the age of 40, it is said to be presbyopia. Its first symptoms are problems with reading – first of all, fine print, and later also ordinary text.

This is when many patients reach for their first “reading” glasses, but they do not solve the problem completely. With the glasses (for reading), things near you can once again become clearly visible, but when you want to look into the distance, you have to take off the glasses about forcing the eye to sharpen its vision. Progressive changes in the elasticity of the lens make it necessary to replace reading glasses frequently.

Some patients opt for bifocal glasses, but this also has its drawbacks – not everyone is able to get used to them (the transition from one area to another is very unnatural for the eye, taking place in leaps and bounds).

Others reach for progressive eyeglasses – the change of the corrective value on the surface of the lens takes place not in steps, but smoothly. The upper part of the lens is used to see objects far away, lower its power increases in such a way as to see intermediate distances (from a few meters to a few tens of centimeters) sharply.

Refractive surgery in the correction of presbyopia

In corneal refractive surgery procedures, correction of presbyopia can be achieved by using micro- or minimonovision, creating zones of different optical power, and by increasing the depth of field.

Patients can use three methods offered by different laser manufacturers: Schwind offers the PresbyMAX method, Bausch&Lomb offers the Supracor method, and Zeiss offers the Presbyond method.

All the treatments mentioned are based on LASIK technology. It can be said that PresbyMax, Presbyond or Supracore presbyopia treatment corresponds to FemtoLASIK treatment.

PresbyMAX method (Schwind)

PresbyMAX creates biospheric, multifocal ablative profiles in both eyes. This is achieved by optimizing each eye in the central area for distance and in the peripheral area for distance. This means that after a period of familiarization, binocular vision at all distances is possible.

PresbyMAX is available in three variants that 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.

The multifocal ablative profiles of PresbyMAX procedures are reversible if the eyes are not able to adjust to their effects.

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.

Presbyond method (Zeiss)

It involves laser correction of presbyopia in such a way that one eye sees better for distance and the other for near. In addition, the appropriate use of the natural asymmetry of our eyes, combined with the work of the laser, makes it possible to create a so-called “combined” zone (Überblendvisus, Blur Zone), so that each eye also sees well at intermediate distances.

The use of Presbyond avoids the negative effects of classic monovision. By controlling spherical aberration, it is possible to produce clear binocular vision in the intermediate zone. This increases the depth of focus of the image without exceeding the toxic level of aberration that deteriorates the quality of vision.

A special feature of the procedure is that the visual areas of the lenses complement and overlap each other, resulting in the most natural visual impression possible. Patients usually adapt to their new way of seeing very quickly after Presbyond surgery.

The principle of cross-fade vision with expanded depth of field is also applicable to intraocular lens implantation.

Supracore (Bausch&Lomb)

SUPRACOR is a unique, clinically proven laser procedure designed to help patients see objects up close again while maintaining distance vision. SUPRACOR treats one or both eyes and provides good vision at all distances (near, intermediate and far).