Take-home message: Excimer laser ablations to the cornea (PresbyLASIK) to create a multifocal cornea may be an alternative treatment for patients with presbyopia.
Reviewed by Gustavo E. Tamayo, MD
Bogota, Colombia—Presbyopia can be confounding for patients who do not want to wear glasses or contact lenses. Though corneal inlays or IOLs may be standard procedures, the latter is a definitive surgical procedure with the potential for significant complications.
Advances in technology now offer a third alternative, excimer laser ablations to the cornea (PresbyLASIK) to create a multifocal cornea, said Gustavo E. Tamayo.
“This is surgery completely outside the eye,” said Dr. Tamayo, founder and partner, Bogota Laser Refractive Institute, Bogota, Colombia. “It is a variation on the LASIK, LASEK or PRK procedures that most of us are already familiar with. And with wavefront-guided instruments, the excimer laser treatment it is both reversible and repeatable.”
New application of familiar technology
Using excimer laser energy to treat presbyopia is not a new concept, Dr. Tamayo noted.
In general practice, about 93% of ophthalmologists who opt for surgical treatment of presbyopia opt for excimer laser monovision and 7% choose an IOL.
But earlier excimer techniques did not always produce optimal results. Patients complained of visual symptoms, such as halos and flairs. Visual acuity did not always reach target.
“Improvements in wavefront technology, better understanding of ocular aberrations, improvements in the excimer laser itself, and the advent of femtosecond lasers to help create flaps have made this the right time to consider this technique,” he said. “It is particularly useful for younger patients with presbyopia, especially those between about 40 and 55 who are years away from needing cataract surgery.”
The key to successful presbyopia treatment is to center treatment on the visual axis, not on the pupil, he continued.