Presbyopia is popularly known as “eyestrain” and is the difficulty in seeing near objects clearly. It is caused by the loss of elasticity of the crystalline lens, a natural lens of the eye located between the cornea and the retina. The crystalline lens has the quality of accommodation, which is the ability to focus on objects depending on the distance at which they are located. Over time, and progressively, the crystalline lens loses elasticity, transparency and focusing ability.
Eyestrain initially causes the sensation of blurred vision when reading, which is initially compensated instinctively by moving the object to be read away from the eyes. It can also lead to eyestrain and headache. As presbyopia progresses, it involves difficulties in middle distance vision.
When does presbyopia usually occur?
Presbyopia eventually affects us all with age. The first effects usually appear after the age of 40, and it is rare to find someone in his or her 50s who has not noticed the first symptoms. Hyperopic patients generally notice it earlier than myopic patients.
When is surgery necessary?
Presbyopia is a consequence of the natural wear and tear of the eye. The purpose of surgery is to enable the patient to carry out daily activities without the need to wear glasses, and this is the decisive factor when opting for surgery.
The surgical approach can be carried out with different techniques, which are established according to the age, the refraction required and the particular characteristics of each patient. At the Institut de la Màcula we carry out a personalized study with different complementary tests including corneal topography, corneal aberrometry, specular microscopy and optical biometry with the Pentacam AXL Wave platform, which integrates the latest technology. With this, together with an evaluation of the patient’s needs and refractive situation, we decide if surgery is necessary without ever forcing the indication and always looking after the patient’s best interest.
What innovative techniques are currently available for presbyopia surgery?
Although there are many projects being developed to tackle presbyopia, the only definitive solution, and the one we recommend at the Institut de la Màcula for the patient’s safety, is the extraction of the crystalline lens. This element is replaced by a monofocal lens, an EDOF lens or multifocal (trifocal) lenses.
Each of these lenses has its own specific indications and performance. In general terms, monofocal lenses correct the far distance, EDOF lenses correct the far and intermediate distance and trifocal lenses correct the far, intermediate and near distance. This type of surgery is ambulatory and under local anesthesia. The non-dominant eye is operated on first and, within a week, the dominant eye is operated on. The operations take no more than 20 minutes.
What will the postoperative period be like and when will the patient be able to lead a normal life?
Recovery is practically immediate. The only indication is the application of a treatment based on eye drops during the weeks following the surgery, as well as avoiding sports that involve considerable effort or risks for the eye during the first weeks.
Are the results definitive or is it possible that a reoperation may be required?
The objective of crystalline lens surgery with intraocular lens implantation for presbyopia correction is that the patient can lead a life independent of glasses. With this surgical technique the result is practically definitive. However, correction with corneal refractive surgery may be necessary if the refractive results are not as required.