Corneal Surgical Approach in the Treatment of Presbyopia

Purpose: The aim of this paper is to outline the various corneal approaches to the treatment of presbyopia and discuss their effectiveness Method: Most corneal surgical procedures involve LASIK. Supracor uses a progressive ablation profile to provide an aberration optimized smooth transition from distance to near correction. In presbyLASIK a hyper positive area is created at the centre of the cornea for near vision and the periphery provides a focus for distance. The Intracor procedure is an intra-stromal treatment using a femto-second laser. It creates concentric rings with the stroma. These bring about central steepening of the cornea. Monovision corrects one eye for distance and the less dominant eye for near. Conductive keratoplasty uses heat generated by high radio frequency current to alter the corneal stroma. Corneal small aperture implants or inlays are inserted into the cornea through a pocket created by femtosecond laser to improve the near and intermediate vision. Results: Supracor offers the best prospect but the high retreatment rate is a major drawback. Intracor and corneal inlays offer the best hope for elimination of reading glasses but reduction of distance vision, loss of binocularity and reduction of the effect overtime limit their use. Monovision for a selective group of patient is still the best alternative. Conclusions: There is no ideal corneal surgical approach to presbyopia. The future may involve more than one approach, perhaps a corneal approach for patients under 50 and a lens solution for older patient. The ideal procedure and best outcome is still some way off.