Presbyopia Surgery - Victor Hugo Laser Centre

PRESBYOPIA

You are more than 40 years old.
You need more and more light to read.
It is becoming impossible to read small letters without corrective lenses.
You are PRESBYOPIC.

Presbyopia is not a refraction disorder but the inevitable ageing of the crystalline lens. Emmetropic presbyopic see faraway objects clearly but close-up vision is blurred.

When a person is reading or engaged in any other close-up activity, the crystalline lens becomes naturally deformed. Tiny fibres called "zonules" surround the equator of the crystalline lens 360 degrees around. When the cillary body contracts, the zonules release their hold on the edge of the crystalline lens. The crystalline lens then changes shape, thanks to its elasticity, and increases its refractive power. Without realising it, we automatically refocus the images on the retina, in order to obtain a clear view of nearby objects.

Over time, it loses its elasticity and can no longer assurer accommodation to see nearby objects. Presbyopia is characterised by this diminution, then disappearance, of accommodation. Persons who suffer from presbyopia have no problem reading street signs or watching a movie at the cinema but are unable to accommodate to decipher small writing in a book or undertake precision manual tasks.

Presbyopia can combine with other optical disorders of the eye:

Sufferers of myopia see well close-up without accommodating, but their vision is blurred from far away without optical correction. When they become presbyopics, only slightly myopic persons can read close-up without accommodating.

Hypermetropic presbyopics are unable to read close-up without corrective lenses, and improvement in hypermetropia (farsightedness) partly corrects their presbyopia. Laser correction (Laser-Presbylasik) usually makes it possible to forego corrective lenses.

Being astigmatic is an advantage for reading as the patient ages, as a slight astigmatism partly offsets presbyopia.

The surgical solution offered is the Laser-Presbylasik. This multifocal programming technique can be used in hypermetropic, astigmatic or myopic patients.

So what is this Presbylasik laser?

The Presbylasik laser creates two zones of vision on the cornea: one peripheral for faraway vision and the other central for close-up vision. The laser makes the cornea multifocal, so that it can simultaneously receive images of close-up and faraway objects, through a multifocal programming of the laser sculpture.

This programming technique can be used in hypermetropic, astigmatic or myopic patients. It can also be done in emmetropic patients who suffer only from presbyopia. The procedure is done on one eye after the other and lasts less than 10 minutes.

First step: The Femtosecond laser cuts the cornea.

The femtosecond laser cuts a thinner flap (thus saving tissue) that is more reliable (fewer complications), more reproducible and optically neutral (no interference with the treatment for myopia). It replaces the microkeratome, a sort of small carpenter’s plane, which can lead to per-operatory problems, such as blockage or poor control of flap thickness.

Second step: The Excimer Nidek EC 5000 laser calculates all corrections in patients more than 40 years old with a multi-zone treatment.

The Presbylasik laser technique produces functional results within a few hours. After the procedure, the patient has blurred vision but can see well enough to move about alone, unassisted. The Presbylasik laser does not interfere with the patient’s general condition.

The benefit of this correction remains in part over time, even if presbyopia continues to evolve years after the Lasik. Uncorrected vision may decline a little for reading and then requires wearing of small glasses to read the smallest letters. Vision will nonetheless remain much better than it was prior to Lasik.

Healing takes a few months, and it is always possible to fine-tune the correction of the presbyopic patient after a few weeks if healing is not perfect. Nine patients out of 10 Presbylasik-treated patients wear no corrective lenses. The others occasionally wear corrective lenses to see faraway or nearby objects.

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