Advances in the Surgical Correction of Presbyopia

George O. Waring IV, MD; Duncan E. Berry, BA


Int Ophthalmol Clin. 2013;53(1):129-152. 

In This Article

Scleral Modifications

Scleral spacing is based on the theory that the lens is under increased equatorial zonular tension during accommodation, and thus, any procedure that increases the distance between the lens equator and the ciliary muscle (thereby increasing tension) should reverse presbyopia.[62] There is limited published data on this technique; however, an interesting finding from 1 study was a modest improvement in near vision in the nonoperated eye.[63] The mechanisms underlying this finding have yet to be explained and indicate that further studies are necessary to not only demonstrate the efficacy of the treatment but to further understand the mechanisms in play.

There are 2 technologies under development that aim to correct presbyopia by modification of the sclerociliary complex—PresVIEWTM Scleral Implant (Refocus Group, Dallas, TX) and the LaserACE system (Ace Vision Group, Silver Lake, OH). The LaserACE procedure has received the CE mark and utilizes the VisioLite erbium-YAG laser (Ace Vision Group) to ablate 600-μm laser spots in the sclera which are presumed to free the ciliary muscle to contract normally. The spots delivered in a diamond matrix pattern of 9 laser spots into each oblique quadrant. At the 2011 ASCRS meeting in San Diego, Hipsley and colleagues presented data from 134 eyes and reported a restoration of 1.25 to 1.5 D of accommodation which remained stable through 18 months. They also reported that 89% of patients had near UCVA of J3 or better postoperatively, 89% had intermediate UCVA of J3 or better and there was no statistically significant loss of distance visual acuity.