A number of procedures are available to address presbyopia, each with its advantages and disadvantages.
Most patients with presbyopia can be treated successfully, and patient satisfaction is high, said Dr Nader Robin, in private
practice in Grenoble, France.
He evaluated the results of presbyopic correction using an intrastromal Intracor femtosecond laser procedure (Technolas Perfect
Vision), intracorneal ring (Kamra, AcuFocus), and hyperopic presbyLASIK and discussed their use in clinical practice.
Dr Robin and his colleagues performed 162 procedures to correct presbyopia from June to December 2010. All patients wanted
correction of near and far visual acuity and they were divided into the following four groups based on refractive status:
moderate to severe myopia; mild myopia; emmetropia; and hyperopia, he explained.
Moderate to severe myopia
The 68 patients in this group underwent a conventional thin-flap LASIK procedure that aimed for –1 to –1.5 D of residual myopia
for near vision and emmetropia in the fellow eye.
"The patients were highly satisfied in all cases," Dr Robin said. "Six patients still complained of somewhat insufficient
Sixteen patients with low myopia underwent bilateral LASIK with the femtosecond laser with the goal of achieving emmetropia.
A corneal inlay was implanted under a 180-μm flap in the non-dominant near vision eye. All patients underwent low-dose cortisone
therapy for 3 months and dry eye therapy, according to Dr Robin.
All patients expressed high satisfaction with the procedure, with the exception of a 48-year-old woman who expressed dissatisfaction
with the eye with the inlay and requested explantation.
Twenty-six patients underwent an intrastromal Intracor procedure with the femtosecond laser in one or both eyes depending
on the visual results in the first operated eye and if the vision in the first operated eye was insufficient for good near
vision. A total of 42 procedures were performed. Three patients were dissatisfied with their near vision and two patients
underwent a re-treatment procedure. One patient complained about poor night vision 6 months postoperatively.
Thirty-six patients with hyperopia underwent hyperopic presbyLASIK with an additional multifocal enhancement (central positive
correction for near vision) in one or both eyes. Most patients had unilateral presbyLASIK with the goal of achieving emmetropia
in the far vision eye with better near vision in the other eye.
Dr Robin said that the patient satisfaction was very high, but all patients had halos and thought that the distance vision
was inadequate up until 2 to 3 months postoperatively. He shared his thoughts on correcting presbyopia.
"Presbyopic patients are increasingly asking for surgical solutions to their vision problem, and this patient population is
becoming an important part of everyday practice," Dr Robin said. "There is no standard technique to correct presbyopia, and
the preoperative evaluation is complex. The patients need to be assessed very precisely by clinicians with specific training
in this area, I believe."
He also commented that the post-op follow-up period is longer and patients must feel that they are supported by the clinical
team. Re-treatments are being performed more frequently. Acquiring or preserving good distance vision is a key factor in patient
satisfaction, even if they can read without correction.
Preoperative identification of the preferred eye for near vision also is a key factor for success. In most cases, simple procedures
like monovision can be successful and rewarding. Pure emmetropia is the most difficult to manage.
"With the available techniques, we can offer acceptable treatment for almost all presbyopic patients," Dr Robin said. "Patient
satisfaction is usually very high even if there is some loss of best-corrected visual acuity."
Dr Nader Robin is in private practice in Grenoble, France. He may be contacted by E-mail: email@example.com
Dr Robin has no financial interests in the subject matter.