Presbyopia is a condition that develops as a normal part of aging of the eye. It strikes us all regardless of possible underlying refractive errors. The lens grows and stiffens during our life and at a certain point, its accommodation abilities are not enough to allow visual acuity on short distances, since its light-refractive properties are strongly diminished. This usually occurs after the age of 40, typically by the age of 45 years. An underlying positive error when focusing far away insinuates an earlier onset of presbyopia, whereas a small negative error still allows visual acuity without spectacles when focusing close. This however does not mean that the person has good close vision, but rather that the focal point of the eye is near the retina. Consider the next examples: A person with presbyopic sight has a refractive error of -3.0D (dioptries) and can read easily without spectacles on a distance of 33 centimetres. When this person wishes to focus on an item far away, a clear picture is not obtained since the picture is formed in front of the retina instead of at the retina. Even after a correction of the refractive error, spectacles will be needed to focus on items that are close. Moreover, a person with a refractive error of +3.0D cannot form a clear picture focusing close or far away, and will need reading spectacles as well as a corrective procedure for the refractive error. In both cases, the choice of lens type would be multifocal lenses.
If a person has always far-sighted, reading spectacles will come into question when presbyopia sets in. It is, however, inconvenient to put reading glasses on and off continuously, and so these patients often use multifocal lenses. With multifocal lenses it is always a compromise: where you do get the properties to focus both near and far in the same lens, these spectacles require getting used to. The lens edges cause distortion, the area with which you focus on nearby items is very narrow and to get by for example in challenging uneven terrain or when climbing a ladder, one is forced to nod the head back and forth to get information about the surrounding both near and far. In addition, the spectacles need to always be carried along since the patient cannot see clearly near or far without them. Some people simply never grow accustomed to using multifocal lenses.
Many experience the development of presbyopia as debilitating. Luckily, a fast method to attend to the problem is discovered: presbyopia operation. The natural, non-ackommodating and stiffened lens is removed in the procedure, and replaced by an artificial multifocal lens. This artificial lens corrects refractive errors such as far-sightedness, near-sightedness and astigmatism, and offers a permanent optical solution for all of them. In addition, it eliminates the need of spectacles altogether. The results of the operation are permanent and the artificial lens will not need to be changed. Also, a future development of cataract is also excluded since cataract cannot develop in an artificial lens. Hence, it is safe to say that a presbyopia operation solves four problems all at once.
When presbyopia sets in, the next step is to book an appointment to an eye surgeon with experience from thousands of procedures, an extensive customer reference register and preferably with personal experience from a presbyopia operation. These factors ensure that your eye specialist has a good knowledge of different lens type properties, and is able to inform the patient about the benefits, drawbacks, risks and adverse effects of the operation. No underlying refractive error is a hinder for the operation- a presbyopia procedure fits everyone. The very rare contraindications for the surgery are excluded during the pre-examination. However effective, a presbyopia surgery is still a compromise in that an eye sight comparable to that of a 20-year old cannot be accomplished at the age of 50 anymore, but the results from the procedure are nevertheless very good.
While the risks of everyday life are by far bigger than those of a presbyopia surgery, there is a risk for a very rare bacterial infection which has a prevalence of 1/30 000 operations. Complications during surgery are rare and post-operative symptoms related to irritation and swelling are easily treated. Dry eyes is a symptom experienced by everyone during the first months after surgery. It is also common to experience light halos around light sources in the dark. Moreover, driving in the dark might feel uncomfortable for a while after the surgery, and conversely, sunglasses might be increasingly needed when driving in broad daylight. Also, since the artificial lens distributes light, a more powerful light source might be needed for reading. These symptoms are mostly temporary but might become sustained in some patients. Even then they are rarely considered disturbing.
The presbyopia procedure is similar to a cataract procedure but is faster to carry out and has a shorter healing period due to the softness of the artificial lens to be implanted. The procedure itself lasts 5-10 minutes, the post-operative medical care is needed for 3 weeks and the post-operative examination is usually scheduled one month after the surgery.
Symptoms related to the healing process will subside gradually during the first months post-surgery. Up to 98% of patients that have undergone presbyopia operation are satisfied with the outcome and would opt for the procedure again. They would also recommend the procedure to a friend. The remainder of 1-2% experience the adverse effects uncomfortable enough not to be entirely satisfied with the operation. However, one should keep in mind that a 100% satisfactory report is never obtained in medicine, but the highest percentage is nevertheless reached in ophthalmic surgery.
There is no need to suffer from presbyopia since good and safe solutions are available to solve the problem. Prior to the operation, a detailed examination done by a specialist is required, as is a full briefing of the patient. A thorough pre-examination, good surgical technique and the right type of lenses for the right patients result in a satisfied patient and a happy doctor.