Simple Presbyopic Correction Technique

Mahmoud M. Ismail, M.D Ph.D.Professor of Ophthalmology

Al-Azhar UniversityMedical Director

Nour El Hayat Eye CenterThe Author has no financial interest in the material presented

Egyptian Ophthalmological Society

PresbyopiaCorrection

Corneal IOLs Scleral

AddingIntracorneal

lenses

SubtractionLASIK

MoldingLTK/CK

Femto-Second

MultifocalIOLs

AccomodatingIOLs

MonoVision

Presby LASIK ?Continuous change in techniques → unsatisfied results especially for Myopic Presbyopes …….?

Presbyopic Aspheric Ablations

Central Zone: Pupil-size dependentCentral steepeningAccounts for Intermediate and Near

functionPeripheral zone

Distance

Can this induce harmful HOAs ???

PresbyLasik,............. my experience

Target: oblate multifocal cornea (inducing -ve spherical

aberration) to both eyes → balance between far & near ………. BUT: Halos and glare (Very Variable) Distance vision better than near vision (or vice

versa) reduction of binocular vision Intermediate region is always poor Contrast Sensitivity ????? So: patient’s satisfaction is compromised

Facts 1 Patients Implanted with Intracorneal lenses are still not Presbyopes ?

Ismail MM.: Confocal study for intracorneal implants FDA phase 2-A. J Cataract Refract Surg. 2002 March ;28(3):527-30.

Ismail MM Correction of hyperopia by intracorneal lenses, two year follow-up. J Cataract Refract Surg 2006; 32:1657-1660.

Facts 2………….Stenopic effect ????? Reviewer of Journal of Cataract and

Refractive surgery: Acuofocus AC 7000: INTRACORNEAL

IMPLANT Stenopic Implant: → 2mm pin-hole effect 5mm diameter AND :10 microns THICKNESS

Depth of focus

Fact 3 :………………….Near Reflex Esotropia Lens Accomodation……& Miosis and Centroid pupil shift

Technique: during myopic LASIK, dry peripheral zone in down –nasal quadrant

Nasal side

Dry, Dry & Dry → it gets more flat

It gets more steep

PresbyZone

Myopic Ablation Zone

Rt Eye Presbyopic treatment

Presbyopia ..…….to be continued