Laser Eye Surgery for Presbyopia

There are some types of laser eye surgery that can help patients with presbyopia.

Presbyopia is a condition that results from the natural ageing of the eye. The exact mechanism for the development of presbyopia, literally meaning ‘old man eye’, is still unknown, however there are a number of theories.

As we get older, parts of the eye that are vital in focussing begin to lose their ability to function as well as they used to. Specifically, the lens within the eye begins to become less elastic, as do the ciliary muscles that stretch the lens when focussing. These changes cause the refractive power of the eye to decrease, preventing adequate focussing of images from close up, such as words in a book.

Until recently, presbyopia was treated with spectacles and contact lenses however there are a number of new surgical treatments available. Laser blended vision is offered by some laser eye correction centres and involves correcting one eye for viewing objects that are far away, whilst correcting the other to view objects that are close. Both eyes are also able to view partly at the distance they are not corrected for. Some patients can find this problematic at first, however the brain can learn to adapt to this system. Approximately 90% of sufferers are suitable for this treatment. This is also similar to a treatment known as monovision, whereby one eye is treated to see distance, whilst the other is made to see close up. Unlike laser blended vision, the eyes cannot see at distances they are not corrected for and as such this method can cause more problems and take longer to get used to.

Other types of surgery include conductive keratoplasty, which uses energy from radiowaves to shrink part of the cornea. Again, this is only done in one eye, leaving one to view objects up close and the other to view objects at distance. Many patients find treatment in one eye leads to problems with depth perception. Normally both our eyes are responsible for viewing all objects. By having one eye for distance and one eye for close, in essence we are losing binocular vision. This can cause problems such as nausea and trips or falls.

Many patients opt to have a procedure known as refractive lens exchange or clear lens extraction (CLE). This procedure is just like cataract surgery, involving the removal of the natural crystalline lens within the eye and replacement with a man made intra-occular lens (IOL) implant. Recent advances within the field have lead to the production of IOL’s that very accurately mimic the natural lens. These are called ‘true’ or accommodative IOL’s. When implanted they can effectively restore the vision back to normal.

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