Uncovering More Safe and Quick Options

PresbyLASIK is a useful option to correct ametropia and presbyopia, and it is important to know every available option, according to Jaime Aramberri MD.

As the most prevalent visual condition in adulthood, presbyopia has been forecast to increase through 2030 before decreasing due to the incorporation of myopia epidemics. “Presbyopia has a significant impact on quality of life, and it is the main reason to seek refractive surgery today,” Dr Aramberri said.

PresbyLASIK applies a multifocal or EDOF profile to the cornea to achieve an increased depth of field. The attractiveness of this technique is its many advantages over multifocal IOLs: it is not an intraocular technique, it has a better safety profile, and it is a quick surgery under topical anaesthesia with a speedy recovery, which preserves the lens for future surgeries, he explained.

The technique offers two main strategies for near vision—the central option, which adds more power in a central area of the cornea, and the peripheral option, where more power is given to a paracentral-mid area of the cornea.

Dr Aramberri suggested the central PresbyLASIK approach seems to be better because there is a synergy with near miosis. Central corneal higher power, plus its induced spherical aberration, and the small aperture all play in favour of a good near vision. Moreover, he added spherical aberration is natural and easily processed by the brain, there is less tissue ablation, and the surgery is easier to revert.

He observed that an increase in depth of focus of more than 1.5 to 2.0 D impairs visual quality and decreases BCVA. Therefore, focus can only be extended safely up to that limit.

“This is why we have to use micromonovision to add something to the eye—playing more in near—so this addition of refraction, plus the spherical aberration, will achieve a functional near vision,” he said.

Because of pupil dependency, especially the central profiles, understanding pupil dynamics and pupillometry is also essential in the preoperative study to achieve the best results, he added.

There are three popular platforms for PresbyLASIK using micromonovision as a strategy to correct presbyopia with the dominant eye for far and the non-dominant eye for near: PresbyMAX by Schwind, Supracor by Bausch + Lomb, and Presbyond by Zeiss. Even though there are differences in functioning, accuracy, and safety among the platforms, the long-term results show the quality of vision has improved through the years, and patients’ near-vision task performance is comparable to the preoperative situation. Yet, there is a learning curve in the outcomes.

“Results are much better now than they were 10 years ago, and there is some regression of the near effect through time, and this must be explained to the patient,” Dr Aramberri said. “Also, postoperative surveys show a high degree of satisfaction with the outcome.”

Dr Aramberri spoke at the 2024 ESCRS Congress in Barcelona.

Jaime Aramberri MD is ophthalmic surgeon specialised in cataract, refractive, and corneal surgery at Miranza Begitek, Donostia-San Sebastián, Spain, and Miranza Ókular, Vitoria-Gasteiz, Spain. jaimearamberri@telefonica.net