Yes, on more and more patients, especially if they have a concomitant refractive error (myopia, astigmatism, hyperopia), for this error is corrected as the same time.
Surprisingly surgery is the least often performed on patients with perfect distance uncorrected visual acuity, for near vision restoration can sometimes alter distance vision quality.
However, it may be useful to perform surgery on unstable hyperopia, in cases of particular professional requests (entry into the army, police, and so on); in such cases secondary optic correction will be necessary and reoperation considered after hyperopic stability achievement.
No there is no inferior or upper limit. It’s not so much the age that counts as the spectacles dependence as well as a refractive error at distance vision. Nevertheless, surgery should usually not be performed before 48 – 50 years of age.
However, age and potential concomitant presbyopia may influence surgical feasibility as well as the choice of the surgical technique.
No, there are several contraindications. It is the main purpose of preoperative consultation to detect and eliminate inappropriate candidates.
Some patients are not operable at all; others are only eligible for specific techniques. Therefore, your surgeon must have the ability to indifferently perform all surgical procedures in order to let you benefit from the most appropriate one.
It depends on the type of the procedure and the age of the patient. The visual result with multifocal intra ocular lenses is stable for all life long, but these lenses cannot be inserted inside the eye before 50 years of age. With PRESBYLASIK, normal presbyopia progression with time may counteract the initial result; a secondary procedure may be needed a decade later, either by an excimer laser touch up, or by the insertion of a multifocal intra ocular lens.
Contact lens removal is mandatory 48 hours before surgery in case of soft contact lenses, 1 month in case of rigid contact (it is possible to temporarily replace them by soft ones which will be removed 48 hours before surgery).
Surgery is performed under local anaesthesia, by anaesthetic drops instillation. In contrary to popular belief there is no injection in the eye. Oral sedation is given two hours prior to surgery, in order to manage legitimate apprehension.
Both eyes have surgery in the same operative session in case of PRESBYLASIK, 2 to 8 days apart in case of multifocal intra ocular lens. The procedure is fully painless. The patient is discharged one hour later and should be taken home back by a relative. Driving is not permitted the day of surgery.
Presbyopia refractive surgery is extremely safe, provided common sense rules are respected, rules that I have been uncompromisingly following during all my practice: rigorous and appropriate patient selection with absolute respect of all contraindications, use of last generation measurement devices and lasers, operating rooms with highest security standards.
Side effects may happen in the following weeks or months (glare, vision fluctuation, halos); usually minor and impermanent, they do not impact final visual result, even if rarely a touch up may be needed. Surprisingly surgery is less risky than contact lens wearing, especially in terms of infectious risk. This type of surgery has now a long follow-up and has demonstrated its maturity and safety.
Presbyopia surgery causes more discomfort than true pain; visual rehabilitation is fast, taking several hours to one day.
Resume work and driving are fully permitted the day after surgery. Both are one week delayed after PRK. Swimming and combat sports should not be practiced during a month regardless the technique.
Make-up is permitted after a week, as well as sun exposure, provided sunglasses are worn.
Rehabilitation is therefore extremely fast, for patient major happiness and satisfaction.
