Multifocal LASIK (Presbyopia)

Last updated on April 3rd, 2019 at 01:41 pm

Multifocal LASIK (presbyLASIK) is an innovative type of laser vision correction surgery that alters the shape of the eye’s cornea to produce different power zones for seeing at differing distances.

Currently going through U.S. clinical trials, the procedure has actually been carried out in other nations for the previous several years, with appealing results.

While it’s uncertain when FDA approval might occur, multifocal LASIK eventually might be a new alternative in the United States for fixing presbyopia, which causes near vision to blur as the eye’s natural lens starts to lose its focusing versatility.

If you are nearsighted and have presbyopia, you might have the ability to see up close without your typical glasses or contact lenses however not when you are using them.

No one escapes presbyopia, which begins to appear at about age 40. Solutions for presbyopia include multifocal eyeglasses, multifocal contact lenses, synthetic lenses (IOLs for cataract surgery)– and now, multifocal LASIK eye surgery.

LASIK For Presbyopia: How It Works

Producers of excimer lasers and femtosecond lasers are establishing multifocal corneal treatments so people with presbyopia will have the ability to see clearly at all ranges without checking out glasses, bifocals or other multifocal spectacles.

For presbyopic eyes, the only currently offered FDA-approved LASIK procedure offers monovision. This means one eye is fixed for much better range vision, and the other eye is fixed to enhance near vision. Lots of people can not adapt to this sort of sight, which can cause problems such as loss of depth understanding.

Unlike monovision, multifocal LASIK fixes presbyopia like this:

  • An excimer laser improves your cornea into various zones for near, far and intermediate vision. Your brain then picks which zone it has to translucent to obtain the sharpest vision, depending on whether a things is near or far.
  • In each zone, light is bent or refracted differently, permitting people with presbyopia to regain good vision at all distances– just like how multifocal contact lenses proper presbyopia.

However, multifocal contact lenses resting on the surface area of any eye can move and cause vision distortions. Multifocal LASIK, on the other hand, offers fixed, fixed zones directly on the eye’s surface area.

Just as multifocal contact lenses and other synthetic lenses have various styles, numerous techniques are used in multifocal LASIK to determine precisely how the cornea should be shaped to accomplish the best correction for presbyopia.

PresbyLASIK With Distance Vision In The Center

Refractive surgeon Robert L. Epstein, MD, director of the Mercy Center for Corrective Eye Surgery near Chicago, prefers a main zone for distance vision in presbyLASIK.

“I picked this method because of the possibility of easy reversibility to pure monofocal distance correction, should it be required,” stated Dr. Epstein, who is taking part in U.S. medical trials. “I felt this was safer than the opposite method, where the peripheral cornea is corrected for distance and the center for near.”

Dr. Epstein’s method is similar to that of French refractive surgeon Alain Telandro, MD. Dr. Telandro has actually established a multifocal ablation software application called Pseudo-Accommodative Cornea (PAC) and has actually trained surgeons in numerous countries to perform the procedure. He approximates that more than 10,000 people have gone through the PAC multifocal LASIK procedure.

Dr. Telandro approximates that 80 to 85 percent of people who undergo this kind of presbyLASIK are pleased with the outcomes, and just about 10 percent need a second “enhancement” treatment. He also states the PAC multifocal LASIK treatment offers good intermediate vision along with good range and near vision, letting you work comfortably at a computer without restorative eyewear.

PresbyLASIK With Near Vision In The Center

Jorge L. Alio, MD, PhD, teacher of ophthalmology at Instituto Oftalmologico de Alicante in Alicante, Spain, prefers a multifocal ablation with the center of the cornea shaped for near vision, surrounded by a peripheral zone for distance vision.

What Is the Best Type of LASIK Surgery?

Dr. Alio says this approach makes it possible for the surgeon to provide a more powerful correction for reading and other near vision jobs. He likewise believes that the near-center approach causes less aberrations than distance-center ablations. For both factors, Dr. Alio thinks near-center multifocal LASIK offers higher flexibility from reading glasses than distance-center techniques.

LASIK For Presbyopia Based On Refractive Errors

The best multifocal LASIK style for you may depend on what sort of refractive errors you have, in addition to presbyopia.

Gustavo Tamayo, MD, director of the Bogota Laser Refractive Institute in Colombia, has been performing multifocal LASIK since 2000. He has actually developed a multifocal laser treatment for scientific trials sponsored by Abbott Medical Optics (AMO), maker of a popular excimer laser system for LASIK surgery. Dr. Tamayo and AMO are examining a distance-center multifocal LASIK profile for myopic patients with range vision issues, and a near-center method for hyperopes with near vision problems.

PresbyLASIK With Modified Monovision

With this technique using presbyLASIK in one eye just, you still may need reading glasses, though to a lesser degree. You likewise may have sharper distance vision with modified monovision, compared with going through multifocal LASIK in both eyes.

If you go with customized monovision, depth understanding at a lot of ranges is unimpaired, although some problems have actually been reported at distances of about a foot or nearer. So if you are a carpenter or a dental expert, you need to have no difficulty adapting to this kind of vision in most instances.

The most common symptom related to customized monovision has been small distance blur. This is since the presbyLASIK eye is corrected to be a little myopic so that you have much better near vision.

Dr. Epstein stated strong range vision is essential with LASIK of any kind. So he favors the customized monovision approach of using presbyLASIK in one eye and wavefront-guided (custom) LASIK in the dominant eye. He has actually used this approach in investigational presbyLASIK procedures because 2003.

“We simply can not match what monofocal wavefront-guided LASIK offers good distance vision,” he said.

He said tolerance for customized monovision quickly can be evaluated prior to a procedure is done. Whereas straight monovision normally supplies just two centerpieces (far and wide), modified monovision with multifocal LASIK adds a 3rd, intermediate centerpiece that otherwise would be unobtainable with monovision.

“This provides vision over a broad series of ranges,” he explained. “It’s likewise a lot easier to adjust to the milder difference in correction in the eyes when we use presbyLASIK in the non-dominant eye and wavefront-guided range LASIK in the dominant eye.”

Dr. Epstein stated the presbyLASIK eye in customized monovision likewise can be “tuned” to emphasize range vision and leave intermediate vision unchanged. This means near vision is somewhat minimized, but far vision is corrected in the presbyLASIK eye to about 20/30 at distance to help people who have occupations and interests such as business driving, heavy devices operation or motorcycle riding.

Can PresbyLASIK Be Reversed?

The capability to “reverse” a procedure if it does not exercise also is being evaluated in medical trials and will be a significant factor in FDA considerations that might lead to approval of presbyLASIK.

“It ends up that we have actually almost never ever had to reverse the presbyLASIK eye,” Dr. Epstein stated. “Only one patient has actually had a turnaround by request. And we purposefully reversed presbyLASIK in a patient who was getting a cataract years after LASIK, so that she might have a multifocal lens implant instead.”

Dr. Epstein said refractive surgeons have found it more difficult to reverse presbyLASIK with a main zone designated for near vision than for a main zone designated for distance vision.

How Effective Is Multifocal LASIK?

Studies of investigational presbyLASIK procedures have shown regularly good outcomes, with the majority of patients seeing 20/20 or 20/25 in the range and being able to read newspaper print up close without glasses.

In one study of customized monovision with monofocal wavefront LASIK performed on the dominant eye and presbyLASIK performed on the non-dominant eye, 91 percent of subjects reported having no requirement of corrective eyeglasses throughout the day.

If your vision was normal except for presbyopia prior to multifocal LASIK, it’s possible your range vision might be blurry right away after the surgery. This problem may not necessarily disappear, either. It’s also possible you’ll experience minimized contrast sensitivity and/or a propensity to see halos around lights at night.

Decreased contrast level of sensitivity suggests trouble seeing things against backgrounds of comparable colors. However some research shows that reduced contrast level of sensitivity related to multifocal LASIK may be only temporary and tends to vanish in three to 6 months.

If you develop cataracts after multifocal LASIK surgery, you will still be able to have cataract surgery. But changes made to your cornea during the LASIK procedure make it a bit more difficult for your cataract surgeon to identify the correct power for your intraocular lens to give you an ideal visual result after cataract surgery.

It’s possible you might need to wear spectacles after cataract surgery or you may require extra corneal refractive surgery to regain acceptable vision for owning and/or checking out without glasses.

Finally, there is no warranty that results of your multifocal LASIK surgery will be irreversible. If your eyes change as the years go by after your LASIK surgery, future surgical improvements might be required. Another possible complication connected with the procedure can include an inability to see as well as you once did, even with the assistance of glasses or contact lenses after surgery.

Cost of PresbyLASIK

If you are seeking only near vision correction, the standard LASIK rate is applied. If, nevertheless, you are interested in both LASIK (to fix range vision), and Presby LASIK (to correct near vision), the Presby LASIK treatment is priced as an “add-on” — just $300-$350 per eye is contributed to the already estimated LASIK cost.

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