J Korean Med Assoc.  2019 Dec;62(12):616-622. 10.5124/jkma.2019.62.12.616.

Surgical treatment of presbyopia I

• Hyun J

• KMID: 2465355
• DOI: http://doi.org/10.5124/jkma.2019.62.12.616

Abstract

Presbyopia is an age-related condition that progressively decreases the ability to focus on near objects. Minimally invasive surgical techniques have been developed to improve near vision, including laser in situ keratomileuses (LASIK) and corneal inlay. Most have similar approaches using monovision or increasing the depth of focus. Monovision laser refractive surgery is a combination of conventional LASIK, LASIK which creates a multifocal cornea (central near or peripheral near) and aspheric micro-monovision LASIK with a special ablation profile, which develops spherical aberration. Conductive keratoplasty is a method that uses radiofrequency energy to shrink the mid-peripheral corneal stromal tissue. However, it is not used because of regression. A corneal inlay is a small device that is implanted in the corneal flap or pocket made by a femtosecond laser. It is inserted into the non-dominant eye. There are various inlays such as the Flexivue Microlens (refractive), Raindrop (corneal shape-changing), and KAMRA (small-aperture) inlays. However, the safety and effectiveness of these inlays have not been proven over a long follow-up period, so care is required when performing inlay implantation. All presbyopia treatments can improve near vision but also have limitations and side effects such as reduced far vision, contrast sensitivity, or increased glare. Therefore, it is essential to select patients carefully. Mechanisms associated with presbyopia are not fully understood, and presbyopia remains challenging for ophthalmologists.

Keyword

Presbyopia; Monocular vision; Laser in situ keratomileusis; Inlays

MeSH Terms

Contrast Sensitivity
Cornea
Corneal Transplantation
Follow-Up Studies
Glare
Humans
Inlays
Keratomileusis, Laser In Situ
Methods
Presbyopia*
Refractive Surgical Procedures
Vision, Monocular

Figure

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  Figure 1 Schematic cross-section of bi-aspheric PresbyMAX profiles.

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  Figure 2 Schematic concept drawing of aspheric micro-monovision (laser blended vision). Laser treatment expands the depth of focus to each eye, creating a customized fusion of the two images in the intermediate zone. D, diopter.

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