Home / Refractive surgery / Presbyopia surgery
Presbyopia
surgery
PresbyLASIK · PreLex · Multifocal lenses
Presbyopia is not a disease but a matter of wear: the natural lens loses its flexibility and can no longer focus up close. No technique prevents it or delays it. There are, however, two ways to free yourself from it, and the choice between them depends first of all on your age.
Eligibility
Does this apply to you?
These criteria point the way; they do not decide. Only the pre-operative assessment, which measures the actual geometry of your eyes, can settle the question.
How far will you see sharply?
Indicative diagram: the result depends on the technique and the lens chosen
Favourable profile
- Presbyopia that gets in the way every day: reading, screens, your phone
- Stable refraction and no progressive eye disease
- Healthy retina and macula, checked by OCT
- Regular cornea and an adequate tear film
- Acceptance of night-time halos and of the neuroadaptation period
- Realistic expectations: doing without glasses in most situations, not in all of them
What rules it out or means waiting
- Glaucoma, even when well controlled: multifocality is poorly tolerated
- AMD (age-related macular degeneration), even at an early stage, or any disease of the macula
- Severe dry eye
- Driving at night for work, or very often
- Expecting perfect vision without glasses in every circumstance
Techniques
The options to consider.
None is better than the others in absolute terms: each one answers a specific anatomical situation.
PresbyLASIK
Between 45 and 55, while the natural lens is still clear. The laser makes the cornea multifocal; the natural lens stays in place and will go on ageing.
PreLex
From 55. The stiffened natural lens is replaced by a multifocal lens implant. It is permanent, and it rules out any future cataract.
Multifocal and EDOF lenses
The family of lens you choose determines the range of sharp vision you get, from distance only all the way to near.
Monovision
One eye corrected for distance, the other for near. A simple compromise, tested beforehand with trial contact lenses.
What you need to know
The point that is too seldom explained.
Recovery here is longer and more variable than after standard refractive surgery: a few days to a few weeks for functional vision, several weeks to several months for good-quality vision, and stabilisation between one and three months, sometimes up to six. The reason is not healing but adaptation. Correcting presbyopia relies on an optical trade-off: sharing the light between several distances means giving less of it to each one. Hence the night-time halos and the slight loss of contrast. They are not complications but consequences of the method. The brain learns to sort the images in three to six months. Patients who accept this before the operation are satisfied; those who discover it afterwards rarely are.
SFO information leaflets (in French)
These leaflets are published by the Société Française d'Ophtalmologie (French Society of Ophthalmology). They describe the procedure, its results and its risks. They serve as the basis for informed consent, but do not replace the consultation.
Frequently asked questions
What I am asked most often.
From what age can presbyopia be operated on?
PresbyLASIK can be considered between 45 and 55, on a clear natural lens. After 55, PreLex becomes the more logical solution.
Will I see halos at night?
Yes, this is expected with a multifocal lens. They fade with neuroadaptation, which takes three to six months.
Will I be able to do without glasses entirely?
The realistic aim is to do without them in the vast majority of situations. A pair of glasses for occasional use is still helpful for small print or in dim light.
Can presbyopia come back after PreLex?
No. The natural lens is removed and the implant does not age. The capsule may become cloudy; this is treated with a YAG laser during a consultation.
Can I try out the result before deciding?
Yes, with trial contact lenses that simulate the chosen compromise. This is particularly useful before monovision.
Find out whether it is possible for you
The questionnaire gives you a first indication in three minutes. The pre-operative assessment measures what cannot be guessed: your corneal topography, your corneal thickness and the condition of your retina.
Dr Emmanuel Halimi
Ophthalmic surgeon · RPPS 10100555084 · Medical Council of Hauts-de-Seine no. 92/23003
Page written and approved by the surgeon.
Last medical review: