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BCLA CLEAR Presbyopia: Management with corneal techniques

2024; Elsevier BV; Volume: 47; Issue: 4 Linguagem: Inglês

10.1016/j.clae.2024.102190

1476-5411

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

Ocular Surface and Contact Lens

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