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No one technique fits all for presbyopia
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VIENNA — Physicians have made many attempts in multiple directions over the years, but presbyopia is still a challenge.
“We have not been able so far to develop one procedure that fits all the needs,” Jorge Alió, MD, PhD, said at the European Society of Cataract and Refractive Surgeons meeting.
There are basically four options today, he said. One is pharmacological treatment, which may be available in the coming years and might be a promising option for early presbyopes. The second is corneal inlays, which are still a controversial option and in decline since the closure of ReVision Optics, manufacturer of the Raindrop.
“Outcomes with inlays have been controversial from the start, and there are still several question marks on the reliability of the studies,” Alió said.
Results are overall inconsistent. “Some patients are happy, some patients are not,” he said. “In my opinion, some years will pass before the technique can flourish again.”
PresbyLASIK is successful, as long as specific rules are followed. First is a careful selection of patients, particularly with regard to pupil size.
“We need an adequate pupil size in photopic conditions and an angle kappa of less than 0.5 mm. In these conditions, PresbyMAX (Schwind) — that is the technique I use — is very successful and gives very good results in early, intermediate and late presbyopes,” Alió said.
Early presbyopes might need an enhancement later in life, which consists of inducing micro-monovision of 0.75 D. This solution will still be viable when the patient develops cataract and is operated with implantation of a monofocal lens or, possibly in the future, an accommodating lens.
“Finally, we have the intraocular options. Multifocal lenses dominate the scene now, but there are also phakic lenses such as the IPCL (Care Group) and the EVO Visian (STAAR Surgical) that can relieve from the refractive error that appears with presbyopia,” Alió said. – by Michela Cimberle
Reference:
Alió J. Laser correction of presbyopia. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 22-26, 2018; Vienna.
Disclo sure: Alió reports he is a consultant for Zeiss, Presbia and several other IOL manufacturing companies.