PresbyLasik – Laser surgery for presbyopia
PresbyLASIK is a refractive surgery technique based on LASIK, the most frequently performed procedure worldwide for correcting vision problems. As its name suggests, it is a LASIK technique combined with optical adjustments to compensate for presbyopia (age-related loss of focusing ability). The procedure takes only a few minutes and is performed under local anesthesia. A period of adjustment lasting a few days or weeks is then necessary to readjust to your new visual cues. This technique allows you to be independent of glasses for more than 90% of your activities.
What is PresbyLasik?
PresbyLasik is a laser technique used to correct presbyopia. It is an evolution of LASIK corneal treatments, allowing for the restoration of distance, intermediate, and near vision without glasses.
The laser technique takes place in 2 stages, using 2 lasers:
The femtosecond laser – the first laser to create a thin corneal lenticule that is repositioned at the end of the procedure. The lenticule acts like a bandage, making the operation painless and reducing healing time and complications.
The excimer laser – the second laser used to reshape the cornea to correct visual defects. It is the same laser used for PRK, but its settings are adapted.
How does it work?
Presbyopia is an age-related loss of focusing ability. No medication, eye drops, or exercise can reverse it. There are two PresbyLasik techniques to compensate for this loss and restore clear vision at all distances, thus compensating for presbyopia:
Monovision – Also called switching, the technique consists of correcting the dominant eye for distance vision and the non-dominant eye for near vision (residual myopia).
Multifocality – Multifocal LASIK involves creating multiple focusing zones on the cornea to establish clear vision at all distances. The technique is inspired by multifocal implants and lenses.
Who is eligible?
The ideal candidate for PresbyLASIK is a patient bothered by their presbyopia, aged 40 to 50-55 years old, who no longer wishes to wear glasses except in rare situations: prolonged driving, working on a computer all day, etc.
An alternative – PreLex
PresbyLasik partially compensates for the loss of accommodation (presbyopia). When this is too advanced, the surgical result will not be sufficiently satisfactory and will not be permanent (you will only benefit from it for 4 to 5 years).
After age 50, the question arises of a therapeutic alternative: PreLex, short for Presbyopic Lens Exchange, or in French, clear lens surgery. The procedure essentially involves bringing forward cataract surgery (for vision loss due to clouding of the lens) before a cataract develops.
A multifocal implant that corrects presbyopia can treat all refractive errors: myopia, hyperopia, astigmatism, and presbyopia. The procedure provides glasses independence more than 90% of the time and eliminates the need for cataract surgery later on.
Pre-operative consultation and assessment
The pre-operative assessment is carried out at your surgeon's office. It is essential in order to evaluate your visual impairments and the treatment options. The consultation includes:
An interview about your visual needs and habits: work, hobbies, sports,…
A measurement of vision with and without correction.
A complete ophthalmological examination including a search for dryness, corneal abnormalities and a fundus examination.
Topography – 3D reconstruction of the cornea to look for thinning or deformation.
Following this assessment, the most appropriate surgical technique will be proposed to you.
How does the PresbyLasik procedure work?
PresbyLasik procedures are performed in a refractive surgery clinic. There is no hospitalization, but you will spend approximately 1.5 to 2 hours there.
Before the operation – The preparation
The previous days:
Do not wear your contact lenses for 5 days before the procedure.
On the day of the procedure, take a shower with soap and water. Wash your face WITHOUT exfoliating products.
Do not wear makeup or tight hairstyles such as buns, you may be uncomfortable lying under the laser.
Upon arrival at the clinic:
A nurse will instill drops of anesthetic (Oxybuprocaine) to numb your eyes.
You will be dressed in a gown or disposable pajamas.
A hairnet will keep your hair in place.
In the theater:
The surgeon will have previously configured the laser.
You will be lying on a stretcher which will be slid under the laser.
Your head will rest in a comfortable headrest.
The operation – The PresbyLasik procedure
The operation takes place on 2 lasers:
First laser – The Femtosecond – This is the preparation laser
The surgeon places a lens on your eye.
You will feel a slight pressure followed by a suction sensation. At this point, your vision will become blurry.
The laser then takes about 10 seconds, it is painless and makes no noise.
The step will be repeated on the other eye.
2nd laser – Excimer – This is the corrective laser.
The surgeon works under strict sterile conditions and disinfects your face and eyes with Betadine.
He then places a blepharostat to keep your eye open.
The lenticule created at the femtosecond is lifted and then the excimer treatment is performed.
The laser treatment lasts 10 to 20 seconds. It emits a buzzing sound and a smell of burnt hair may be present.
Once the laser treatment is complete, the cover (lensicle) is put back in place.
The treatment is then performed on the other eye.
Recovery – After the operation
PresbyLasik surgery for presbyopia allows for a rapid recovery. Here's what to expect:
An initial check is usually carried out the day after the operation to verify the correct positioning of the lenticule.
The eye will be irritated but vision will be normal.
You will be able to resume a quiet, sedentary job the very next day.
Antibiotic and anti-inflammatory eye drops should be used regularly to calm the inflammation and prevent any secondary infection.
Moisturizing eye drops can help to soothe dryness.
Example of a prescription:
Chibrocadron: 1 drop 3 times a day for 15 days
Vismed: 1 drop 2 to 10 times a day depending on the dryness for 3 months.
Vision after PresbyLasik – How effective is it?
An adjustment period will be necessary after the operation. This will take from a few days in the case of a refractive error to a few weeks (or even months) in the case of multifocality.
Ultimately, the hoped-for vision will be:
10/10 from a distance on the dominant eye and 7-8/10 (Parinaud 4) up close.
10/10 up close on the non-dominant eye and 6-7/10 at a distance.
With both eyes 10/10 far and near (said 10/10 – Parinaud 2 or 3).
Independence from glasses is therefore expected for 80 to 90% of daily activities. A small pair of reading glasses for extended periods or night driving is sometimes necessary.
Side effects and complications
PresbyLasik is a true surgical procedure. Post-operatively, it will be necessary to distinguish between:
Side effects: mild, frequent and in no way indicative of surgical failure.
Complications: serious, rare, unpredictable but with a risk of lasting effects.
Side effects
The main postoperative side effects are:
Redness and irritation for an average of 5 to 7 days.
Subconjunctival hemorrhage – Blood spotting sometimes lasting up to 15 days.
The drought, which can last for several months.
Light halos – Rarely bothersome, they tend to fade away.
Complications
Complications are inherently unpredictable. The main ones to note are:
Abscess – Postoperative infection of the cornea.
Displacement of the lenticule (cap) due to poor healing or several years later.
Chronic keratitis.
PresbyLasik and cataract
Having PresbyLasik surgery also means anticipating that you are having the surgery at an age sometimes not far from that of cataract surgery, because the latter is operated on at 67 years on average in France.
Keeping your pre-operative test results will allow the surgeon to better calculate the implant during your procedure. PresbyLASIK, however, does not affect the post-operative outcome of cataract surgery.
Frequently Asked Questions
Can a poorly tolerated PresbyLasik be reversed?
Yes. It is possible to perform corrective surgery if the cornea is thick enough. However, it is best to wait several weeks before judging the final result.
What is the difference between Lasik and PresbyLasik?
Technically, LASIK and PresbyLASIK are performed on the same machines. However, PresbyLASIK is designed to correct presbyopia in addition to the myopia, hyperopia, and astigmatism treated with LASIK.