Presbyopia Surgery: overview, types, procedure, complications

Presbyopia Surgery: overview, types, procedure, complications | HealthSoul

Presbyopia is an age-related condition which decreases the person’s ability to see nearby objects clearly. It can not be cured but can be managed. Reading glasses or contact lenses are common modalities for the management of presbyopia but surgical options are also available nowadays.

Surgical procedures have their own advantages and disadvantages. Patients may still need glasses after the surgical procedure.

Types of surgical procedure

There are different types of surgical procedure like

Refractive eye surgery

It is also known as laser eye surgery and procedure like LASIK, PRK/LASEK are the most common technological procedures for refractive eye surgery.

Conventional monovision: One eye is treated for farsightedness and the other eye is treated for nearsightedness with the help of LASIK. The person is able to see the near as well as far objects. The quality of vision varies between patients. The depth perception for objects at intermediate distances may decrease as the one eye is focused for far objects while the other eye is focused for near objects. The person may still face issues performing high precision tasks or in near tasks performed in low lighting conditions.  Therefore, patients require special purpose glasses or contact lenses while performing activities like night driving. These additional glasses will improve the far vision in the non-dominant eye and optimize the distance vision. Monovision might not be adequate for everybody. So, doctors recommend to try monovision contact lenses before opting for monovision surgery.

LBV: laser blended vision is an advanced form of LASIK which is used to treat presbyopia. It is different from the conventional monovision as it takes care of the intermediate distance range too.

These surgical procedures have their own complications and risks.

Intraocular lens exchange or refractive lens exchange

It is another surgical procedure in which the natural lens of the eye is replaced by an artificial lens. The doctors may recommend in individuals with severe presbyopia or patients who are also suffering from clouding of lens in which refractive eye surgery is not generally effective. The procedure is very similar to that of cataract surgery. There are various types of IOL available as monovision, multifocal, accommodating. In the monovision IOL, the lens is inserted in one eye to correct for near vision and the other eye is left untreated for the far vision. The multifocal or accommodating types of IOL improve the near vision significantly while the distance vision remains normal. This option is preferred in people who are also suffering from hyperopia.

Procedure: the whole procedure takes around 15 minutes. It can be performed on an outpatient basis. The surgery is comfortable as anesthesia is used and you won’t feel any pain. The eyeball is cut open at the edge of cornea and the lens of the eye is removed and then replaced with a synthetic lens. It is not visible on the outside. It is done in each eye separately in the interval of about one week as recovery takes about this much of time period. It takes around several weeks for the full results.

In people with severe refractive error, refractive lens exchange is a better option than LASIK. It can be used to treat any degree of hyperopia along with presbyopia but IOL is costlier than LASIK. You may need glasses in monovision IOLs as similar to conventional monovision. New and more promising intraocular lenses are under trial and may be available in the market in few years.

Side effects and complications of this procedure are similar to that of cataract surgery and include

  • Increased eye pressure
  • Infection or bleeding inside the eye
  • Droopy eyelids
  • Dislocation of the intraocular lens
  • Retinal detachment especially in people who are nearsighted.

Refractive Eye Surgery | HealthSoul

Intracorneal Inlays

Principle: Corneal inlays are small size ring or diaphragm like devices which sharpens the near vision while maintaining the normal far vision. These inlays are inserted in between the layers of cornea. It is done in non-dominant eye. Dominant eye is that eye through which an individual prefers to see the things when one of the eyes is closed. It improves near vision in the non-dominant eye while the dominant eye is left untreated. There are two types of corneal inlays available

  • Small aperture inlays: One of the first kind of these inlays approved was Kamra inlays which is around 3.8 mm in diameter and about half the thickness of plastic wrap (used for storing food). It has a small opening in the center of around 1.6 mm. The entire procedure to insert the Kamra corneal inlay takes around 15 minutes and the patient can soon resume the work within 1 or 2 days. The small hole in the center creates a pin hole camera effect which narrows the field of vision and improves the quality of near vision.
  • Refractive corneal inlays: These are under review by FDA currently. These are transparent inlays with different areas providing different focal or magnifying power. This would enable eye to see objects at various distances. The eye automatically adjusts to that focal power.

The surgery is done in awake state but local anesthesia is provided to prevent pain sensation.

Difficulty seeing at night or in dim light, halos or glare are some of the side effects which can be there depending upon the type of inlays.

Corneal inlays can be combined with LASIK to manage additional refractive problems too like hypermetropia, myopia or astigmatism. It is less invasive when compared with intraocular lens exchange and thus have fewer side effects. It can be done for people whose cornea is very thin to be able to qualify for LASIK.

Talk with your ophthalmologist about various surgical treatment of presbyopia who would recommend you the best suitable procedure for you.

Intracorneal Inlays | HealthSoul