Surgical monovision. One option for people 40 to 60 years old with presbyopia but otherwise healthy eyes is surgical correction to produce monovision, in which one eye is corrected for close-up vision, leaving the other for distance vision. This approach doesn’t fix the stiffened lenses that are the underlying cause of presbyopia, but it can eliminate the need for bifocals or multiple sets of glasses, and it may even enable you to read without glasses.
Doctors use various procedures to make the correction. Laser surgery techniques include LASIK, photorefractive keratectomy (PRK) and laser thermal keratoplasty (LTK), each of which reshapes the cornea or the area around it to provide correction. (The technique used depends on your particular circumstances.)
If you choose laser surgery and never had focusing problems until presbyopia developed, the surgeon will correct one eye so you can see up close, leaving the other eye with your natural ability to see far. If you’re both myopic and presbyopic, the doctor can correct your nondominant eye for near vision and your dominant eye for distance. It may take several surgeries to get the desired result, and the results may not be lasting.
Another technique used for monovision is conductive keratoplasty (CK). This method is similar to laser surgery but doesn’t actually use a laser. Instead, CK uses short bursts of radio waves to shrink and reshape the cornea. One limitation is that it can take a few months before the full benefits are apparent. CK may also carry a slight risk of causing astigmatism.
Monovision isn’t for everyone. It is vital that your eyes are healthy, even if you have presbyopia; no other eye defects, such as cataracts, glaucoma or corneal problems can be present. Some people may find it too difficult to adjust to having different focusing abilities in each eye. If you’re considering having this surgery, the FDA advises you to try monovision with contact lenses first, to find out whether you can adjust to having each eye focus differently.
Lens-replacement surgery. Improvements in the lenses used for cataract surgery have also provided another surgical option for people with presbyopia—albeit one that is an “off-label” use, meaning it’s not FDA approved, and one that is controversial. Variable-focus, implantable lenses enable people who undergo cataract surgery to see objects at various distances. Some ophthalmologists are now implanting these lenses in people without cataracts in order to correct presbyopia. This requires that your natural lenses be removed first, as is done in cataract surgery.
It’s important to keep two things in mind before undergoing this surgery for presbyopia. First, it will not be covered by insurance unless you have cataracts, and the cost can be as high as $5,000 for each eye. Second, many ophthalmologists are reluctant to perform this procedure in people without cataracts because of the risks and lack of information about long-term safety and effectiveness.
Anterior ciliary sclerotomy. Another procedure that is not FDA approved for presbyopia, but is sometimes performed, is anterior ciliary sclerotomy. In this procedure, the ophthalmologist makes a series of incisions in the sclera, the white outer layer of the eyeball, to provide more room for the lens to change shape with age. The theory behind this approach is not proven, and few studies have been published about its safety or effectiveness.