Presbyopia Treatment

Presbyopia is the loss of the lens's ability to change the eye's focus through accommodation, during which the eye muscles alter the shape of the lens. Presbyopia starts in the early forties, and ultimately everyone is affected.

The main issue is similar to that of hyperopia. The focal point of light rays from nearby objects remains behind the retina and is out of focus. In hyperopia, this is due to the eyeball being shorter than normal. In presbyopia, the reason for the condition is that the aging lens becomes stiffer and loses its flexibility. This makes it difficult or impossible for the light rays necessary for accommodation to bend sharply enough, causing the focal point to come before the retina.

It can be even more challenging to read when you’re tired, at night, or in low light. Presbyopia can occur regardless of any existing vision defect.

The first sign of presbyopia is the need to hold objects away when reading. Over time, this blurry vision increases, and headaches in the forehead and temple areas occur. Forcing the eye to focus on nearby objects can eventually bring additional problems. After reading, it may temporarily become difficult to see distant objects clearly, as they also require accommodation to focus.

The only solution for presbyopia is usually optical correction (reading glasses). Individuals who wear corrective lenses for myopia may need bifocal glasses (where the upper part is for distance vision and the lower part is for near vision) or use two separate pairs of glasses.

Due to the progressive worsening of presbyopia, prescriptions are often updated frequently up to late sixties. By this age, presbyopia stabilizes, and from around 60-65 years old, the lens's loss of flexibility causes the eye’s focusing ability to effectively cease; at this stage, seeing up close becomes entirely reliant on glasses. However, myopic individuals can take off their distance glasses when looking up close, allowing for easier near vision.

Patients with presbyopia struggle to see objects closer than 50 cm. Therefore, they can see better by pushing objects further away. Over time, if near vision remains impaired, it may be accompanied by headaches in the forehead and temple areas.

How is Presbyopia Treated?

There are many treatment methods applied worldwide for this issue. Each of these methods has its own advantages and disadvantages. Currently, the most reliable method accepted worldwide for treating presbyopia is intraocular multifocal lens operations and PRESBYOND laser treatments, which are successfully performed in our hospital.

• Bifocal Glasses
• Multifocal (progressive) Glasses

Multifocal contact lenses: Patients suitable for these lenses achieve successful results when wearing them. However, patients over 40 may experience issues with use due to reduced tear film quality.

Monovision with contact lenses (leaving one eye myopic): Whether you are suitable for this treatment can only be determined during your initial examination.

Accommodation issues in the aging eye begin around the age of 45. Using the PRESBYOND laser accommodation area method, this accommodation problem can be resolved with a refractive surgical approach, providing good vision at far, intermediate, and near distances. It allows a very precise intervention, utilizing corneal refractive surgery to enhance depth of field and improve visual sharpness.

By utilizing the spherical aberration naturally present in the eye, the scope of the personalized laser intervention has expanded in many ways compared to conventional monovision laser methods, reaching a broader patient population.

In PRESBYOND Laser Accommodation Area, before refractive surgery, the intervention is performed considering the "wavefront data" specific to the individual.

PRESBYOND Laser Accommodation Area aims for clear vision at all distances, near, intermediate, and far, with almost no compromise.

Many patients may start reading on the same day.

A wide range of patients can benefit from the PRESBYOND Laser Accommodation Area

Myopic

Hyperopic

Astigmatic and even

Presbyopic patients who only need glasses for near vision

PRESBYOND Laser Accommodation Area

One step beyond conventional monovision

The workflow is similar to conventional monovision laser treatment. However, since it provides personalized correction, it is especially advanced in terms of results.

It is the next step toward achieving excellence in eye treatment for presbyopic patients, physiologically optimized. In conventional monovision, while the dominant eye is made nearly zero for distance, the non-dominant eye is left mildly myopic up to -1.5D for near vision. This micro monovision strategy is supported by a method that creates continuous refraction throughout the entire optical zone of the cornea, thereby increasing depth of field. The PRESBYOND Laser Accommodation Area is a completely personalized treatment that takes into account the patient's functional age and preoperative spherical aberrations. As a result, the two images created for near and far vision for each patient are seamlessly combined; we call this "Accommodation Area".

 

The Accommodation Area facilitates the brain's ability to combine images from both eyes. This is a significant advantage over conventional monovision. In addition to excellent near and far vision, patients with the PRESBYOND Laser Accommodation Area experience very good visual acuity and contrast sensitivity at intermediate distances. They adapt quickly, and many are happy that they no longer need to wear glasses.

Therefore, most patients with the PRESBYOND Laser Accommodation Area tolerate this situation (up to 97%)1

In conventional monovision treatment methods (both surgical and contact lenses), the dominant eye is made almost zero. The non-dominant eye is generally left myopic up to -3.0D for correction of near vision. This method aims to provide the ideal vision for both near and far. After the procedure, the brain has to process two separate images with different levels of correction.

Scientific studies have shown that to achieve clear images at both near and far distances, only about 59-67% of patients can successfully combine both images.1 Those who tolerate this method are left with an uncorrected gap known as the "Blurred Area" at intermediate distances. In addition to blurry images, side effects such as reduced contrast sensitivity and a decrease in seeing with both eyes may occur. Also, getting accustomed to perceiving both images as a single image generally takes a long time.

Conventional monovision methods have drawbacks. It is not a suitable option for a group of patients.

Generally, conventional monovision methods use standard ablation profiles. PRESBYOND Laser Accommodation Area, however, includes personalized applications for each eye due to increased depth of field.

PRESBYOND Laser Accommodation Area presents a truly personalized approach to treating presbyopic patients. Preoperative wavefront data taken for each eye is included to achieve depth of field. Thus, a separate personal nomogram is created for each eye to meet the ideal target. The monovision part of the procedure is adjusted before surgery, considering the patient's tolerance. Additionally, different optical zone selections are made based on the patient's pupil size.

PRESBYOND Laser Accommodation Area is an ideal method for addressing the loss of accommodation due to age, meeting the needs of patients aged 40-60. This method is also the least invasive approach to resolving presbyopia.

The LASIK procedure emerged in 1990 and was accepted and began to be applied in the United States in 1999. The PRESBYOND Laser Accommodation Area method also utilizes the long-established LASIK procedure. The treatment planning for both eyes in PRESBYOND Laser Accommodation Area is carried out with the proven ZEISS CRS-Master® program and the MEL 90 Excimer Laser platform.

Considering purely visual outcomes, the PRESBYOND Laser Accommodation Area provides clear vision at all distances, near, intermediate, and far, compared to conventional monovision. Even better, almost all patients are freed from needing reading glasses.1-4,6

Because a tailored treatment is provided for each individual, the PRESBYOND Laser Accommodation Area ensures excellent visual acuity for both near and far vision. Unlike conventional monovision methods, the PRESBYOND Laser Accommodation Area also offers good vision at intermediate distances within the Accommodation Area with both eyes. Clinical studies show that functional vision with both eyes is preserved, with virtually no loss of contrast sensitivity.1 Additionally, side effects such as seeing multiple images with a single eye have been nearly completely eliminated.

PRESBYOND Laser Accommodation Area is a physiological solution and represents a method that permits the simultaneous use of both eyes to treat presbyopic patients.

PRESBYOND Laser Accommodation Area is an effective and proven method for treating presbyopic patients, including those without distance glasses and those with astigmatism (up to 2.0 D cylinder), with refractive errors ranging from -8.0 D to +2.0 D.

The distinct feature of the PRESBYOND Laser Accommodation Area technique is the patient's immediate perception of the positive visual effect.1-4,6

A significant advantage of treatment with the PRESBYOND Laser Accommodation Area is its acceptance by more patients compared to conventional monovision. The PRESBYOND Laser Accommodation Area is effective in treating up to 97%1 of vision problems associated with presbyopia, whereas this figure remains at 59-67%5 for conventional monovision. Even patients with no need for distance glasses and those with astigmatism can be treated. It truly has much greater success potential compared to any method that offers a comparable alternative.