BCLA CLEAR Presbyopia: Management with corneal techniques

Jennifer P. Craig, Allon Barsam, Connie Chen, Obinwanne Chukwuemeka, Neema Ghorbani-Mojarrad, Florian Kretz, Langis Michaud, Johnny Moore, Lucia Pelosini, Andrew M.J. Turnbull, Stephen J. Vincent, Michael T.M. Wang, Mohammed Ziaei, James S. Wolffsohn

Research output: Contribution to journalArticlepeer-review

Abstract

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 reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques 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. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and 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.

Original languageEnglish
Article number102190
Number of pages23
JournalContact lens & anterior eye : the journal of the British Contact Lens Association
Volume47
Issue number4
Early online date8 Jun 2024
DOIs
Publication statusPublished - Aug 2024

Bibliographical note

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).

Keywords

  • Conductive keratoplasty
  • Corneal refractive surgery
  • Intracorneal inlay
  • KLEx
  • LASEK
  • LASIK
  • Orthokeratology
  • PRK

Fingerprint

Dive into the research topics of 'BCLA CLEAR Presbyopia: Management with corneal techniques'. Together they form a unique fingerprint.

Cite this