BCLA CLEAR Presbyopia: Management with corneal techniques


Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report provides an overview of the evidence for the treatment profile, safety, and efficacy of the range of corneal techniques currently available for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. Presbyopia correction by conductive keratoplasty involves application of radiofrequency energy to the mid-peripheral corneal stroma which leads to mid-peripheral corneal shrinkage, inducing central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.

Publication DOI: https://doi.org/10.1016/j.clae.2024.102190
Divisions: College of Health & Life Sciences > School of Optometry > Optometry & Vision Science Research Group (OVSRG)
College of Health & Life Sciences > School of Optometry > Optometry
College of Health & Life Sciences
Funding Information: BCLA CLEAR™ Presbyopia was facilitated by the BCLA, with financial support by way of educational grants for collaboration, publication and dissemination provided by Alcon, Bausch + Lomb, CooperVision, EssilorLuxottica, and Johnson & Johnson Vision.
Additional Information: Copyright © 2024 The Author(s). Published by Elsevier Ltd on behalf of British Contact Lens Association. This is an open access article under the CC BY license (https://creativecommons.org/licenses/by/4.0).
Uncontrolled Keywords: Conductive keratoplasty,Corneal refractive surgery,Intracorneal inlay,KLEx,LASEK,LASIK,Orthokeratology,PRK,Ophthalmology,Optometry
Publication ISSN: 1476-5411
Last Modified: 10 Jul 2024 17:49
Date Deposited: 19 Jun 2024 13:51
Full Text Link:
Related URLs: https://www.sci ... 367048424000821 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2024-06-08
Published Online Date: 2024-06-08
Accepted Date: 2024-06-01
Authors: Craig, Jennifer P.
Barsam, Allon
Chen, Connie
Chukwuemeka, Obinwanne
Ghorbani-Mojarrad, Neema
Kretz, Florian
Michaud, Langis
Moore, Johnny
Pelosini, Lucia
Turnbull, Andrew M.J.
Vincent, Stephen J.
Wang, Michael T.M.
Ziaei, Mohammed
Wolffsohn, James S. (ORCID Profile 0000-0003-4673-8927)



Version: Published Version

License: Creative Commons Attribution

| Preview

Export / Share Citation


Additional statistics for this record