Surgical Correction of Presbyopia

Lenticular, Corneal, and Scleral Approaches

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


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

In This Article


Presbyopia is a growing cause of disability due to an aging population. Multiple approaches for surgical correction exist, and its treatment will need to be approached specific to each patient's needs and desires, expectations, hobbies, stage of crystalline lens dysfunction, and other ocular characteristics. Various options may be available, but it is up to the patient and surgeon to decide what is best for the patient knowing each technology involves some compromises.

Corneal inlays are a relatively new treatment option, with a variety of devices and technology on the horizon. They are able to provide significant improvement in UNVA, while maintaining or improving UIVA, and minimal effects on UDVA. Contrast sensitivity and stereoacuity are largely unaffected. Scleral modification and CK also show promise in improving intermediate vision. Excimer laser approaches are also able to provide improvements in UNVA, but can negatively affect distance vision and contrast sensitivity. Also, because of the tissue ablation, the authors are concerned about the mechanical stability of the cornea following these procedures.

Lens-based surgery also remains a viable option for patients. With the variety of options available, both surgeon and patient must balance the needs versus the drawbacks of each lens. The multifocal IOLs are able to provide excellent distance and near vision, whereas the accommodating IOL and enhanced depth of focus IOL arenable to provide excellent distance and intermediate vision.

With new technologies continuing to emerge, there is no shortage of choices in the refractive surgeon's toolbox.