Presbyopia Surgery

Is it necessary to have a presbyopia operation? Do I or will I have presbyopia?

In normal conditions, to be able to focus on objects in near vision, we subconsciously use what is called “accommodation”. This is the lens’ ability to focus and defocus on objects according to requirements. Presbyopia is the loss of this ability to focus on near objects and is related to age. The lens deteriorates over time and hardens, losing the ability to change its shape to see objects clearly. This begins to appear from the age of 40-45. The lens loses its accommodative capacity over time which ultimately causes blurriness. This is a gradual process which usually stops at around 60 years of age and happens naturally. Common symptoms include loss of the ability to see very small letters, headaches, letters which “join together” or the inability to focus up close.

Diagram of the eye of a person with presbyopia; the crystalline lens does not accommodate and there is no clear image on the retina (Image from Oculentis GmbH)
Diagram of the eye of a person with presbyopia; the crystalline lens does not accommodate and there is no clear image on the retina (Image from Oculentis GmbH)

Normally, the easiest way to correct presbyopia is with near vision spectacles. Depending on the patient’s age, eye health and requirements, there are different types of surgery available to correct tired sight.

Below we have provided a simplified description of the solutions available to you.

PRESBYOPIA: USE OF SPECTACLES and/or CONTACT LENSES

Spectacles

The use of spectacles is one of the easiest options for correcting distance and near vision at the same time.  A few years ago, the ophthalmic lenses most commonly used were “bifocals”, which only correct these two distances but do not cover intermediate distances.  This solution is no longer used today and has been replaced by progressive lenses, which now offer very good visual quality and cover all the patients’ needs, enabling vision at all distances.   Regardless of the lens used, patients are usually fully dependent on these solutions and in most cases would like to do without spectacles for aesthetic reasons.

Contact Lenses

Patients with presbyopia can use contact lenses. The simplest method for correcting it with contact lenses is through what is called “monovision”. This is a solution which is used frequently and is very affordable.  It involves correcting the dominant eye for distance and the non-dominant eye for near vision. It is true that not everybody can tolerate monovision and that in some cases spectacles will be required for driving, because monovision reduces three-dimensional vision (stereovision).
An alternative method used today is progressive contact lenses. An adaptation process is required to adjust to the use of these lenses and in the end the patient may be unable to tolerate them, although the success rate is quite high today thanks to technical advances in contact lenses.

In general, the first adaptation to contact lenses in patients with presbyopia is unsuccessful. Patients often suffer dry eye, and it is difficult to fully meet their desired objectives, as it is often not possible to see perfectly at all distances at the same time.

WHAT SURGICAL ALTERNATIVES ARE THERE?

There is no perfect way of reconstructing the elasticity of the crystalline lens through medication or any surgical procedure. However, there are operations which can achieve good vision at near distances.

There are two types of operations: corneal or lens (with intraocular lens). Your trusted ophthalmologist will recommend the best solution to you after performing the appropriate tests and studying your particular case.  In our forum you can read about the individual experiences of other patients. 

WHAT ARE THE ADVANTAGES ENJOYED AFTER PRESBYOPIA SURGERY?

One of the main aims of presbyopia surgery is to eliminate dependency on spectacles for both distance and near vision. This most certainly results in an improvement in the patient’s quality of life.

As well as being an important factor aesthetically, wearing spectacles gives rise to certain limitations in terms of visual field which are no longer a problem after presbyopia surgery.  It enables you to be more independent in everyday situations such as driving, walking up or down stairs, cooking, checking your mobile or working at a computer.

Another advantage of not needing spectacles after this type of surgery is in sporting and leisure activities, such as golf, tennis and swimming. The ability to move around freely and see well at all distances allows enjoying these activities more easily.