Presbyopia , or age-related farsightedness , is the loss of visual acuity for seeing near objects. It usually begins around age 40 and gradually worsens until age 65, affecting 100% of the population. The cause is simple: the lens of the eye ages, losing elasticity and the ability to continuously change shape to focus on near objects. Presbyopia is typically corrected with single-vision, bifocal, or progressive lenses. However, to address this natural effect of eye aging, surgery is the most satisfactory and effective solution. The latest advances in refractive surgery allow for the use of lasers or intraocular lenses to counteract the aging of the lens.
Laser surgery
Laser treatment for presbyopia is similar to that used to correct myopia, hyperopia, and astigmatism. This procedure involves reshaping the cornea with a laser, allowing for extended reading without glasses thanks to the increased refractive power.
However, it is acknowledged that this procedure has a limited effect over time, so sooner rather than later the patient will need glasses again for all situations. That is why at Clínica Nivaria we reserve it for very select cases and prefer to emphasize the importance and value of intraocular lens correction.
Correction of presbyopia using an intraocular lens
This procedure involves removing the natural lens and replacing it with a state-of-the-art multifocal lens that performs its function. This lens can offer various focusing ranges, although we highlight three: distance, intermediate, and near. The brain determines the most appropriate focus for each situation (pseudo-accommodation). With some lenses, this guarantees the patient a full range of vision, providing excellent vision at any distance without glasses or contact lenses. Today, there are many models of intraocular lenses that correct not only presbyopia but also other refractive errors and provide varying levels of visual acuity.
This treatment is considered the definitive technique for correcting vision problems. It is performed under conscious sedation and with topical anesthetic eye drops.
Furthermore , correcting presbyopia with an intraocular lens prevents the development of cataracts . In other words, it's not an additional procedure; it's the cataract surgery that will be needed later, performed a few years before the lens finishes deteriorating.
It's important to note that to permanently correct presbyopia, you have to wait until the lens of the eye has already begun its aging process. This means reaching a certain age, usually around 45-50 years old. At this point, the lens in each eye can be replaced with a single-focus (monofocal) lens or a multifocal (multifocal) lens. With monofocal lenses, presbyopia can be improved through monovision , leaving one eye (usually the dominant one) focused for distance vision and the other for near vision. Multifocal lenses , on the other hand, allow both eyes to see clearly at both distances and near distances. The choice between these two options will depend on each patient's individual characteristics.
In both cases, the procedure is performed through a micro-incision in the cornea, through which the liquefied lens is aspirated using ultrasound. The intraocular lens is then inserted through the same incision. Multifocal lenses that do not require removal of the natural lens are also currently under development.
So, laser or intraocular lens?
The choice between techniques such as laser surgery or intraocular lens implantation will depend on age , corneal health , and the pre-existing refractive error . A good candidate for laser surgery might be a young presbyopic patient with mild hyperopia and good corneal health.
Once the patient meets the necessary requirements, their presbyopia will be corrected with a painless operation. Furthermore, recovery is very quick. The day after surgery, the patient can resume their normal activities, following basic eye care guidelines.
Both procedures are simple, and at Clínica Nivaria, patient follow-up is completely personalized. Our ophthalmology team will advise patients on the schedule and days for their follow-up appointments.
Advantages of intraocular lenses over laser surgery
- Implanting intraocular lenses does not require modifying the cornea . Laser surgery involves reshaping the cornea to give it the appropriate form and change its refractive power. This can make it more fragile and susceptible to injury. Therefore, it is not recommended for patients with thin corneas and those at high risk (boxers, athletes, and other professionals). These groups have the alternative of intraocular lenses.
- Versatility . Intraocular lenses (IOLs) can correct not only refractive errors (myopia, astigmatism, or hyperopia) but also presbyopia , or age-related farsightedness . For presbyopia, just as there are progressive lenses, there are also monofocal, bifocal, and trifocal lenses that offer excellent results for improving near, intermediate, and far vision. The resulting vision is better. IOLs not only correct high prescriptions, something that cannot be done with laser surgery, but they also provide visual acuity approximately 20% greater than what the patient achieves with glasses, contact lenses, or conventional refractive surgery. Shorter recovery. Normal vision after IOL surgery is restored in just 24-48 hours , and the patient can resume their daily activities practically the day after the procedure. For a few days, they should avoid rubbing their eyes, making sudden head movements, or engaging in strenuous exercise. In addition, both eyes can be treated at the same time, if the patient does not wish to go through the same process twice, achieving a quick return to their normal life.
- Fewer side effects. Intraocular lenses are completely biocompatible , very flexible , and do not cause rejection or leave a foreign body sensation in the eye. They are inserted into the eye through tiny incisions that heal quickly. Dry eye and nighttime halos or glare are less frequent in patients with intraocular lenses. Generally speaking, complications in these cases are less severe and are almost always resolved with simple treatments using eye drops. However, although very rare, unforeseen events or complications may arise that require further surgery, but in skilled hands and with adherence to the pre- and post-operative treatment and guidelines, these are exceptional cases.