Surgical Correction of Presbyopia

Lenticular, Corneal, and Scleral Approaches

Michael Greenwood, MD; Shamik Bafna, MD; Vance Thompson, MD

Disclosures

Int Ophthalmol Clin. 2016;56(3):149-166. 

In This Article

Introduction

Presbyopia is a progressive age-related inability to accommodate, resulting in a diminished ability to focus on near objects.[1] This disorder affects an estimated 1.04 billion people worldwide with symptoms beginning around the fourth decade of life.[2] Our understanding of the how presbyopia occurs and the accommodative system comes from nonhuman primate studies that were later confirmed in human studies.[3–11] These studies demonstrated that the lens is the limiting factor in the accommodative response and that the ciliary muscle retains its ability to contract well beyond the onset of presbyopia.[12]

Because of the increasing prevalence and increased interest in reduced dependence on spectacles for reading, novel options continue to emerge. The traditional approach of blended vision with either LASIK or monofocal intraocular lenses (IOLs) following cataract surgery is still an excellent option, but will not be discussed in this entry. Instead, we will focus on the many other technologies that have been developed. In addition to presbyopia-correcting IOLs, several options exist for correction by refractive surgery at the corneal and scleral level. These include: corneal inlays, conductive keratoplasty (CK), presbyLASIK, and scleral implants. The purpose of this review is to provide an overview of cornea-based, lenticular-based, and scleral-based surgical procedures and devices currently in use or in development for surgical treatment of presbyopia.

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