Types of laser eye surgery for presbyopia

Patsy Westcott / 24 September 2015

If your eyesight is worsening, there are surgical solutions. Find out more about laser eye surgery and lens replacement surgery with our quick guide.



Option 1: laser techniques

LASIK (laser-assisted in situ keratomileusis) 

What is it? The surgeon creates a hinged flap the thickness of a human hair from the surface of the cornea, using an infrared laser. The surgeon lifts and folds back the flap before reshaping the cornea using an ultraviolet laser and replacing the flap. 

One eye is adjusted for far-away objects and the other for near objects (monovision). The brain usually adjusts to this to provide balanced binocular vision over a range between arms’ length and the distance. 

Pros and cons. The creation of the flap enables faster healing and less risk of inflammation or infection. Dry eyes can be a problem initially but usually improve. You may still need glasses for dim light, fog or tasks requiring sharp vision, such as reading fine print, threading a needle or night driving. 

Is it for you? Possibly, if you are 50-60 with mild short or long-sight. You should have a contact lens trial that simulates monovision before going ahead to ensure your brain can adapt. 

LASEK (laser epithelial keratomileusis)

What is it? The surgeon softens the protective surface layer of the cornea, the epithelium, with alcohol or a laser and moves it aside before reshaping the cornea. 

Pros and cons. Same as for LASIK for those with thin or unusually shaped cornea. Recovery time is longer and can be more uncomfortable but end result is usually as good. 

Is it for you? Possibly if you are 50-60 with thin or unusually shaped cornea, moderate short sight dry eyes, or dislike the idea of LASIK.

SmILE (small incision lenticule extraction)

What is it? The surgeon makes a small laser incision and peels off a disc-shaped sliver of corneal tissue called a lenticule. This is then drawn out through a keyhole incision, also made by laser, on the edge of the cornea, flattening the cornea, which cures short sight. 

Pros and cons. Fast recovery. More precise than LASIK for people with moderate short-sight. Possibly less likely to cause dry eyes. Technically more difficult so choose an experienced surgeon.

Is it for you? Possibly if you’re 50-60 with moderate short-sight (-3.00 to -10.00) 

Multifocal LASIK

What is it? Multifocal LASIK (aka presbyLASIK) is an adaptation of the LASIK technique specifically designed to make up for the loss of lens flexibility brought about by presbyopia. It includes a variety of techniques. 

In Presbyond® Laser Blended Vision, for example, a laser is used to programme one eye for intermediate and close vision and the other for intermediate and distance vision to produce stereo vision.

Pros and cons. The brain may adapt better than it does to the monovision of conventional LASIK. Can reduce or do away with the need for glasses or contacts for five to 10 years. Natural ageing of the lens (presbyopia) continues so you may eventually need another treatment. 

If you develop cataracts after multifocal LASIK and need lens replacement the surgeon may find it more challenging to determine the correct power of lens needed. 

Is it for you? Possibly if you’re 50+ with presbyopia and short or long-sight or astigmatism. 

Option 2: lens replacement – AKA Intraocular lens exchange (IOL)/Refractive lens exchange (RLE) 

What is it? The surgeon removes your natural lens and exchanges it for a synthetic implant. Artificial lenses haven’t traditionally provided good intermediate vision, and can result in glare and halo. But the latest implants and techniques, which help you focus at all distances, avoid these problems. 

They offer a longer-term solution to presbyopia and eliminate the risk of cataracts (because the lens, which gets cloudy in a cataract) is removed and replaced. 

Pros and cons. About four out of five patients are completely spec-free after modern multifocal implants, and those who do still prefer spectacles usually only need them for specific tasks. Laser procedures may be needed to fine tune focus and get the best out of multifocal lenses. 

For you? Could be the longest-term solution if you’re over 50 and strongly motivated to be spec-free over the full range of distance, or if laser surgery is unsuitable because of eye surface problems or early cataracts. 

Option 3: Corneal inlay 

What is it? The surgeon creates a flap or pocket in the cornea and inserts a tiny ring-shaped device. The inlay works either like a pinhole camera (KAMRA) or to reshape corneal focus (Raindrop).

Pros and cons. Can restore near and intermediate vision while preserving distance vision. Reversible. Has a relatively short clinical track record and normally only implanted in one eye. Unknown if as safe or effective as more tried and tested options described above. Inlay can be removed if there are problems but corneal clarity may be affected.

Is it for you? Could be if you have healthy eyes and a zero or slightly plus prescription. Unsuitable for people with cataracts, glaucoma or other age-related conditions requiring treatments that could be disrupted by the inlay or stop it working properly. This often rules out those aged 70+. 

Read our in-depth article about surgery for poor eyesight in the October issue of Saga Magazine

The opinions expressed are those of the author and are not held by Saga unless specifically stated.

The material is for general information only and does not constitute investment, tax, legal, medical or other form of advice. You should not rely on this information to make (or refrain from making) any decisions. Always obtain independent, professional advice for your own particular situation.