PresbyLASIK Advances as Alternative to Monovision

PresbyLASIK is a sophisticated alternative to monovision for ageing eyes, but patient selection, biometric safety, and the need for neuroadaptation are still challenges, according to Anas-Alexis Benyoussef MD.

The surgical options for presbyopia are continuing to expand. PresbyLASIK is a cornea-based approach designed to address the limitations of monovision LASIK, such as the loss of stereopsis when anisometropia exceeds 1.50 D.

“The arsenal of technologies that we have today for presbyLASIK is based on multifocal approaches with distinct refraction zones, with a priority on strong near vision but with some photic phenomena,” Dr Benyoussef explained. “But we also have extended depth of focus or hybrid approaches, where we try to have an aberration control to elongate focality.”

Among the multifocal approaches are technologies such as the Supracor (Technolas), which creates a hyperpositive dome (+1.00 D to +3.00 D) targeted for moderate hyperopes, and the PresbyMAX (Schwind), a bispheric profile with options for symmetric treatment or monovision. Another approach, called laser-blended vision (LBV), works by adjusting spherical aberrations to extend the depth of focus, allowing clearer vision over a range of distances. Presbyond (Zeiss), for example, combines monovision with spherical aberration to create a blend zone for better results, with myopes and emmetropes among the more ideal candidates.

PresbyLASIK success depends on selecting the right patient. Ideal candidates are 45–55 years old and are especially moderate hyperopes who show good neuroadaptation and satisfaction. Emmetropes are more challenging due to potential loss of distance vision. Proper selection also requires good ocular parameters and patient acceptance of visual compromises.

Exclusion criteria include dysfunctional lens syndrome, small pupils, preexisting contrast loss, binocular instability, and ocular surface disease. In such cases, lens-based procedures are preferable. Overall, success depends not only on treating the cornea but also on the patient’s ability to adapt neurologically. Effectively managing both the patient and the brain is important, as presbyLASIK is a static treatment while presbyopia worsens over time. Tolerance should be assessed preoperatively, for example with contact lens trials. Patients must also be informed that results are not immediate, as neural adaptation and binocular fusion can take up to three months.

Evaluating presbyLASIK efficacy is challenging due to varying study designs and techniques. However, many patients achieve good distance and near vision shortly after surgery. Limitations include a small risk of reduced best-corrected distance vision, decreased contrast sensitivity, dysphotopsia, and potential complications for future IOL calculation.

For the future, presbyLASIK may further expand with a comeback of other corneal solutions, such as allogenic inlays.

“They are on the market—not in [every] country, but [this option] is developing very fast,” Dr Benyoussef said. “The technology is based on an allograft inlay that creates a multifocal corneal profile, leveraging fourth- and sixth-order spherical aberrations to effectively extend the depth of focus.”

Dr Benyoussef spoke at the 2026 ESCRS Winter Meeting in Helsinki.

Anas-Alexis Benyoussef MD, MSc is an ophthalmologist at the University Hospital of Brest, France. anas-alexis.benyoussef@chu-brest.fr