PRESBYOND® LASIK

Dr Au offers PRESBYOND exclsusively at Eye Laser Specialists clinic only

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What is Presbyopia?

Presbyopia is the gradual loss of the eyes' ability to focus on nearby objects. It gradual becomes more noticeable from early to mid 40s and worsens until the age of 65. It is most commonly managed by reading glasses or under-correcting myopia prescription.

Unfortunately traditional methods only allow for sharp focus at one fixed distance and often multiple pairs of reading glasses with varying strengths may be required. More expensive bifocal/trifocal glasses may help improve convenience but not everyone is versed in their usage.

Monovision (with glasses, contact lenses, laser or cataract surgery) is also sometimes utilized which leaves one eye slightly short-sighted to allow for close work but at a fixed distance (typically 50cm or 66cm), while the other eye is adjusted for distance vision. Monovision works well for some patients but some are unable to tolerate it, stereoacuity (3D vision) is also compromised. Vision is also blurry between the two fixed focal points.

What is PRESBYOND?

PRESBYOND is a uniquely developed outpatient laser surgical procedure used to treat Presbyopia. It provides a continuous range of focus for distance, intermediate and near vision. Whilst one eye is made to be better for distance and the other for near, it's unique use of optical physics (through spherical abberation) allow for greater depth of focus than traditional monovision. This enables both eyes to still working together at all times thus preserving 3D stereoacuity vision. PRESBYOND is only available through ZEISS laser suite.

How is PRESBYOND performed?

PRESBYOND is performed similar to LASIK as an outpatient procedure. Here is what happens:

You will be awake during the surgery and no sedation is necessary.
The surgery is generally a comfortable experience with minimal pain.
The eye is numbed with anaesthetic eye drops.
A first laser called the femtosecond laser is used to create a thin piece of tissue (the flap) on the cornea.
The flap is gently lifted.
A second laser, the excimer laser is then used to reshape your cornea.
The flap is replaced and smoothed out. No sutures (stitches) are necessary. The flap adheres (sticks) on its own.
It takes generally 10-15 minutes to perform LASIK in both eyes.

In some cases, a contact lens that acts like a bandage is placed over the cornea to allow proper healing of the flap to occur. This will be removed usually the next day.

Am I a Good Candidate for PRESBYOND Surgery?

Not everyone can have PRESBYOND or will benefit from it. Dr Au and his team will advise you accordingly.

Generally, in order to undergo PRESBYOND surgery in Australia, you should:

Be troubled by Presbyopia (typically after the age of 40) and pass the Laser Blended Vision acceptance test
Be free of cataracts (Otherwise cataract surgery would be surgery of choice)
Not be pregnant
Be free of other eye diseases
Fulfil certain criteria with regards to cornea thickness, cornea shape and refractive error (degree). Patients with thin or irregular corneas, severe dry eye, cataract, glaucoma, uncontrolled diabetes, rheumatoid arthritis and other collagen vascular diseases are unsuitable for laser refractive surgery.

Most importantly, you must have realistic expectations about the outcome of the procedure, and be willing to accept the potential risks associated with it. Fortunately, PREBYOND is very safe, and the results excellent, and most patients are extremely happy with how the procedure has changed their lives.

Benefits of PRESBYOND compared to conventional monovision

PREBYOND is better tolerated than conventional monovision treatment (97% vs 59-67%[1])

Better stereoacuity (3D vision) compared to conventional monovision(whether through cataract surgery or other laser vision systems)[2]

Accuracy and Safety profile of LASIK treatment.

Reversible - Treatment can be repeated for the near vision eye if PRESBYOND is not tolerated, this will however result in the need for reading glasses. This is not easily done if patients have undergone cataract surgery monovision.

Repeatable - Enhancements may be performed to fine tune outcomes. This is not easily done if patients have undergone cataract surgery monovision.

Evans BJ. Monovision: a review. Ophthalmic and Physiological Optics. 2007;27:417-439.
Russo A, Reinstein DZ, Filini O, Archer TJ, Boldini A, Cardin G, Festa G, Morescalchi F, Salvalai C, Semeraro F. Visual and Refractive Outcomes Following Laser Blended Vision With Non-linear Aspheric Micro-anisometropia (PRESBYOND) in Myopic and Hyperopic Patients. J Refract Surg. 2022 May;38(5):288-297. doi: 10.3928/1081597X-20220323-01. Epub 2022 May 1. Erratum in: J Refract Surg. 2022 Jul;38(7):474. doi: 10.3928/1081597X-20220630-01. PMID: 35536710.

What to Expect after PRESBYOND?

Here are important points to note:

Visual recovery after PRESBYOND is quick but not instantaneous.
You will find that your eye sight is still foggy immediately after Presbyond. Vision usually improves gradually over the next 6 to 8 hours. By the next day, you will be able to see well enough to perform most of your daily activities (including driving) and continues to improve over the week.
When the effect of the anaesthetic eyedrops wears off, some patients may experience pain, tearing, burning sensation, scratchiness and/or difficulty opening their eyes, the severity of which varies from patient to patient. These symptoms usually disappear after 6-8 hours. Most patients find the discomfort mild and bearable.
Healing after PRESBYOND is usually more comfortable than with other methods of surgery as the laser removes tissue from the inside of the cornea rather than from the more sensitive surface of the cornea.
You will be prescribed antibiotic and steroid eye drops as well as artificial tears to keep the eyes moist.
The presbyopic benefits may require some time to adapt to (76% within 3 months, 94% by 1 year but can take as long as 18months). Temporary glasses are occasionally utilized to aid adaption.

Most patients are able to return to work a day or two later. Stabilization of vision takes a few weeks, and varies from patient to patient.

What Side Effects, Risks and Complications Should I be Aware of?

Like any other surgery, PRESBYOND has side effects that you need to know about and carefully consider before deciding on having the surgery. Fortunately, PRESBYOND is a very safe procedure and most of the side effects are mild and temporary. These include dry eye, fluctuating vision, hazy vision, haloes and glare in a dim environment and light sensitivity. Over- and under-correction may also occur, and a “top up laser” procedure called “enhancement” may be required in some cases. Serious side effects that can result in loss of vision are extremely rare, and these include severe inflammation, infection and corneal ectasia (weakening and thinning of the cornea).

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