Today there are different options for correcting presbyopia by corneal laser procedure, but all of them have their benefits and compromises. The Monovision is a pseudoaccommodation procedure which works with an anisometropy of up to 2 D. The smaller the anisometropy is the faster a neuroadaptation will be achieved. There could be a decrease of binocularity. The monovision is not well supported by all patients, thus it is important to simulate this correction by contact lenses before surgery. The PresbyLASIK is a corneal multifocal solution for presbyopia correction for emmetropic, myopic and hyperopic eyes. It is a true presbyopia procedure where both eyes will be treated for far, intermediate and near. The disadvantage and compromise is that in some cases there could be a loss of uncorrected visual acuity. The corneal inlay is a solution for emmetropic, presbyopic patients who have a strong intention to read without glasses. The disadvantages could be some side effects as halo, glare, decrease of contrast and far vision. All procedures are potentially reversible in case the patient does not support the correction. An enhancement is possible for Monovision and PresbyLASIK.

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Background: Presbyopia treatment in pseudophakic patients with a monofocal IOL is challenging. This study investigates the refractive results of femto-PresbyLASIK and analyzes presbyopia treatment in pseudophakic eyes. Methods: 14 patients with 28 pseudophakic eyes were treated with femto-PresbyLASIK. The dominant eye was targeted at a distance and the non-dominant eye at −0.5 D. The presbyopic algorithm creates a steepness in the cornea center by using an excimer laser that leads to corneal multifocality. Results: 6 months after surgery a refraction of −0.11 ± 0.13 D (p = 0.001), an uncorrected distance visual acuity of 0.05 ± 1.0 logMAR (p < 0.001) and an uncorrected near visual acuity of 0.15 ± 0.89 logMAR (p = 0.001) were achieved in the dominant eye. For the non-dominant eye, the refraction was −0.28 ± 0.22 D (p = 0.002), the uncorrected distance of visual acuity was 0.1 ± 1.49 logMAR, and the uncorrected near visual acuity was 0.11 ± 0.80 logMAR (p < 0.001). Spherical aberrations (Z400) were reduced by 0.21–0.3 µm in 32% of eyes, and by 0.31–0.4 µm in 26% of eyes. Conclusion: By steepening the central cornea while maintaining spherical aberrations within acceptable limits, PresbyLASIK created a corneal multifocality that safely improved near vision in both eyes. Thus, femto-PresbyLASIK can be used to treat presbyopia in pseudophakic eyes without performing intraocular surgery.

Purpose. To compare efficacy, safety and predictability of hyperopia and presbyopia simultaneous correction by photorefractive keratectomy (PRK) with application of a bi-aspheric multifocal profile on the cornea using PresbyMax software, and hyperopia correction by LASIK. Methods. 25 patients (50 eyes) of the 1st group were operated by PRK with bi-aspheric multifocal profile application on the cornea using PresbyMax software for simultaneous hyperopia and presbyopia correction. The 2nd group included 25 patients (50 eyes) operated by LASIK with aspheric profile application on the cornea for correction of hyperopia. Results. In the group 1, in one year after surgery, binocular distance uncorrected visual acuity (DUCVA) was 0.96 ± 0.16, near uncorrected visual acuity (NUCVA) - 0.77 ± 0.17, intermediate uncorrected visual acuity (IUCVA) - 0.64 ± 0.15. Visual acuity loss up to 0.2 was found in two eyes (4 %). Target refraction in the dominant eye - emmetropia - was obtained in 72% of patients; in 28% of cases, a shift up to -0.75 D was observed. Target refraction in the nondominant eye was found in 68% of patients, 12% of patients had a shift from target refraction of -0.50 D, and 20% of patients - of -0.75 D. Spherical aberration in 6 mm zone was -0.22 ± 0.17 µm. In group 2, in a year after surgery, binocular DUCVA was 1.0 ± 0.10, NUCVA - 0.37 ± 0.16, IUCVA - 0.43 ± 0.12. No monocular best corrected distance visual acuity loss was found. had myopia A clinical refraction shift from target one (emmetropia) of -0.50 D was established in 4% of patients. A spherical aberration in 6 mm zone was -0.10 ± 0.08 µm. Conclusion. PRK with bi-aspheric multifocal profile application unlike LASIK allows not only to achieve hyperopia correction but also to improve near visual acuity in patients of presbyopic age.

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