Docteur Dr Marc Weiser - 61 rue de Rennes 75006 Paris - Téléphone : 01 45 48 31 13 FR EN
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Presbyopia Paris Lasik
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Presbyopia

Introduction

Presbyopia is defined as the progressive loss of accommodation, the latter being the ability of the human eye to focus on nearby objects. This is an age-related refractive error, usually beginning in one’s forties and stabilizing around 60 years old.

What is accommodation? The "autofocus" role of the crystalline lens enables the accommodation, that is, the automatic focusing of the eye on nearby objects.

While reading or engaging in other activities requiring a near vision, the crystalline lens will deform itself owing to the action of the ciliary body, a circumferential muscle tissue to which it is connected by an infinity of small fibrils. These tiny fibers called "zonule" surround the equator of the lens in a 360-degree fashion. Due to its elasticity, the crystalline lens thus deforms itself and increases its refractive power. This allows us to automatically refocus the images on the retina without feeling it, in order to get a clear near vision. However, when one reaches 45 years old, the elasticity of the lens gradually begins to decrease.

The decreasing and subsequent disappearance of accommodation characterizes presbyopia. It is a complex evolutionary process that is corrected by wearing either half-moon, bifocal or progressive glasses.

At the age of presbyopia, only people with moderate myopia may continue to read up close without accommodation, provided they do not wear corrective lenses.

Presbyopia surgical correction has gained major recent improvements. More and more presbyopic patients can benefit from a surgical correction that can now correct distance and near vision.

Two techniques are currently available : presbylasik (excimer laser presbyopia surgical correction) and lens replacement by a multifocal intra ocular lens. Surgical eligibility and choice of the most appropriate are determined after a complete ophthalmologic check-up that will also take in account age, hobbits, concomitant eventual visual refractive errors, and visual requests.

Presbyopia Paris

Presbyopia

Introduction

Presbyopia is defined as the progressive loss of accommodation, the latter being the ability of the human eye to focus on nearby objects. This is an age-related refractive error, usually beginning in one’s forties and stabilizing around 60 years old.

What is accommodation? The "autofocus" role of the crystalline lens enables the accommodation, that is, the automatic focusing of the eye on nearby objects.

While reading or engaging in other activities requiring a near vision, the crystalline lens will deform itself owing to the action of the ciliary body, a circumferential muscle tissue to which it is connected by an infinity of small fibrils. These tiny fibers called "zonule" surround the equator of the lens in a 360-degree fashion. Due to its elasticity, the crystalline lens thus deforms itself and increases its refractive power. This allows us to automatically refocus the images on the retina without feeling it, in order to get a clear near vision. However, when one reaches 45 years old, the elasticity of the lens gradually begins to decrease.

The decreasing and subsequent disappearance of accommodation characterizes presbyopia. It is a complex evolutionary process that is corrected by wearing either half-moon, bifocal or progressive glasses.

At the age of presbyopia, only people with moderate myopia may continue to read up close without accommodation, provided they do not wear corrective lenses.

Presbyopia surgical correction has gained major recent improvements. More and more presbyopic patients can benefit from a surgical correction that can now correct distance and near vision.

Two techniques are currently available : presbylasik (excimer laser presbyopia surgical correction) and lens replacement by a multifocal intra ocular lens. Surgical eligibility and choice of the most appropriate are determined after a complete ophthalmologic check-up that will also take in account age, hobbits, concomitant eventual visual refractive errors, and visual requests.

Presbyopia Paris

PRESBYLASIK

Presbylasik is the most recent and appropriate technique for young presbyopic patients after 45 years of age. Its purpose is to increase corneal asphericity and create a slight myopic shift on the dominated eye. The addition of both effects allows uncorrected near vision restoration.

Initially dedicated to hyperopic patients, this technique is now also available for myopic patients as well as for those who have a very good distance uncorrected vision.

Creation of a slight myopia on the dominated eye is well tolerated by a vast majority of patients, even though if a couple of months are usually requested to achieve final and perfect tolerance. It is possible and requested, during pre op evaluation, to check and eventually reject any candidate that would not perfectly tolerate such mild myopia. The myopic shift on the dominated eye can be adjusted according to the patient specific requests (computer, reading…), sometimes at the time of a free touch-up which is generally performed a couple of months after the initial procedure.

Two main software programs are currently available, on two different excimer lasers. The LBV? (Laser Blended Vision) software is available on our Carl Zeiss Meditec MEL 80 excimer laser; it corrects the dominant eye from far to intermediate vision, and the dominated eye from intermediate to near vision. The simultaneous increase in corneal asphericity improves depth of focus as well as binocular comfort. The Supracor software is available on our Technolas Perfect Vision Teneo 2 excimer laser ; the treatment protocol is quite the same but the difference between both eyes is slighter and compensated by a steepening effect on the center of the cornea which creates some kind of true multifocality on both eyes; various protocols are available (mild ou regular) within various combinations, each of them being dedicated to every single patient.

After surgery patients do not wear any more glasses, except rare and particular circumstances such as night driving and extended fine print reading under poor lightning. Appropriate pre operative patient selection allows extreme satisfaction among the operated patients.

 

Visumax Plateform
lasik Paris

 

Intralase Femtosecond Laser
lasik Paris

 

Laser Excimer Teneo 2 Bausch & Lomblasik Paris

 

Lasik
lasik Paris

PRESBYLASIK

Presbylasik is the most recent and appropriate technique for young presbyopic patients after 45 years of age. Its purpose is to increase corneal asphericity and create a slight myopic shift on the dominated eye. The addition of both effects allows uncorrected near vision restoration.

Initially dedicated to hyperopic patients, this technique is now also available for myopic patients as well as for those who have a very good distance uncorrected vision.

Creation of a slight myopia on the dominated eye is well tolerated by a vast majority of patients, even though if a couple of months are usually requested to achieve final and perfect tolerance. It is possible and requested, during pre op evaluation, to check and eventually reject any candidate that would not perfectly tolerate such mild myopia. The myopic shift on the dominated eye can be adjusted according to the patient specific requests (computer, reading…), sometimes at the time of a free touch-up which is generally performed a couple of months after the initial procedure.

Two main software programs are currently available, on two different excimer lasers. The LBV? (Laser Blended Vision) software is available on our Carl Zeiss Meditec MEL 80 excimer laser; it corrects the dominant eye from far to intermediate vision, and the dominated eye from intermediate to near vision. The simultaneous increase in corneal asphericity improves depth of focus as well as binocular comfort. The Supracor software is available on our Technolas Perfect Vision Teneo 2 excimer laser ; the treatment protocol is quite the same but the difference between both eyes is slighter and compensated by a steepening effect on the center of the cornea which creates some kind of true multifocality on both eyes; various protocols are available (mild ou regular) within various combinations, each of them being dedicated to every single patient.

After surgery patients do not wear any more glasses, except rare and particular circumstances such as night driving and extended fine print reading under poor lightning. Appropriate pre operative patient selection allows extreme satisfaction among the operated patients.

 

Visumax Plateform
lasik Paris

 

Intralase Femtosecond Laser
lasik Paris

 

Laser Excimer Teneo 2 Bausch & Lomblasik Paris

 

Lasik
lasik Paris

Multifocal intra ocular lenses (IOLs)

Multifocal IOLs are available for patients over 50 years of age, especially the hyperopic ones. They should not be used in myopic eyes before 60 years of age and in special conditions request a retinal surgeon prior advice.

Numerous performing and safe multifocal IOL have been currently available. This variety allows the appropriate IOL choice for each specific patient, depending on his particular requests and needs. Some IOLs are specifically designed for intermediate vision (e.g. computer intensive use), some are dedicated for reading at near vision. Mix and match is an option for bilateral correction, in order to have the best-uncorrected visual acuity in all circumstances and distances.

Overall results are quite excellent and lasting; moderate glare and halos perception are frequently noticed in the post operative period, even though they tend to gradually regress within a couple of months after surgery. Night driving is uncomfortable in only 1 to 2% of operated patients.

The surgical technique is exactly the same as the cataract extraction’s one. Instead of removing an opaque crystalline lens as in cataract surgery, the removed lens is clear in presbyopia correction with multifocal IOLs. Such surgery is therefore an elective surgery whose costs cannot be reimbursed, even partially, by French Social Security system. Only private insurance companies may reimburse this kind of surgery, depending on each specific agreement.

implants intra oculaires

 

Multifocal IOL Alcon Restor
implants intra oculaires

 

Multifocal IOL Zeiss
implants intra oculaires

Multifocal intra ocular lenses (IOLs)

Multifocal IOLs are available for patients over 50 years of age, especially the hyperopic ones. They should not be used in myopic eyes before 60 years of age and in special conditions request a retinal surgeon prior advice.

Numerous performing and safe multifocal IOL have been currently available. This variety allows the appropriate IOL choice for each specific patient, depending on his particular requests and needs. Some IOLs are specifically designed for intermediate vision (e.g. computer intensive use), some are dedicated for reading at near vision. Mix and match is an option for bilateral correction, in order to have the best-uncorrected visual acuity in all circumstances and distances.

Overall results are quite excellent and lasting; moderate glare and halos perception are frequently noticed in the post operative period, even though they tend to gradually regress within a couple of months after surgery. Night driving is uncomfortable in only 1 to 2% of operated patients.

The surgical technique is exactly the same as the cataract extraction’s one. Instead of removing an opaque crystalline lens as in cataract surgery, the removed lens is clear in presbyopia correction with multifocal IOLs. Such surgery is therefore an elective surgery whose costs cannot be reimbursed, even partially, by French Social Security system. Only private insurance companies may reimburse this kind of surgery, depending on each specific agreement.

implants intra oculaires

 

Multifocal IOL Alcon Restor
implants intra oculaires

 

Multifocal IOL Zeiss
implants intra oculaires

FAQ Presbyopia

1/ Can surgery be truly performed upon presbyopia?

Yes, on more and more patients, especially if they have a concomitant refractive error (myopia, astigmatism, hyperopia), for this error is corrected as the same time.

Surprisingly surgery is the least often performed on patients with perfect distance uncorrected visual acuity, for near vision restoration can sometimes alter distance vision quality.

However it may be useful to perform surgery on unstable hyperopia, in cases of particular professional requests (entry into the army, police, and so on); in such cases secondary optic correction will be necessary and reoperation considered after hyperopic stability achievement.

2/ At what age is surgery recommended?

No there is no inferior or upper limit. It's not so much the age that counts as the spectacles dependance as well as a refractive error at distance vision. Nevertheless surgery shoud usually not be performed before 48 – 50 years of age.

However age and potential concomitant presbyopia may influence surgical feasibility as well as the choice of the surgical technique.

3/ Are all patients suitable for surgery?

No, there are several contraindications. It is the main purpose of preoperative consultation to detect and eliminate unappropriate candidates.

Some patients are not operable at all; others are only eligible for specific techniques. Therefore your surgeon must have the ability to indifferently perform all surgical procedures in order to let you benefit from the most appropriate one.

4/ Is the visual result stable with time?

It depends on the type of the procedure and the age of the patient. The visual result is stable for all life long with multifocal intra ocular lenses, but these lenses cannot be inserted inside the eye before 50 years of age. With PRESBYLASIK, normal presbyopia progression with time may counteract the initial result; a secondary procedure may be needed a decade later, either by an excimer laser touch up, or by the insertion of a multifocal intra ocular lens.

5/ How long should the contact lenses should be removed before surgery?

Contact lens removal is mandatory 48 hours before surgery in case of soft contact lenses, 1 month in case of rigid contact (it is possible to temporarily replace them by soft ones which will be removed 48 hours before surgery).

6/ Is it possible to perform presbyopia surgery at the same time?

In most cases yes, insomuch hyperopia decompensates and becomes bothering at age of presbyopia.

7/ How is surgery performed?

Surgery is performed under local anaesthesia, by anaesthetic drops instillation. In contrary to popular belief there is no injection in the eye. Oral sedation is given two hours prior to surgery, in order to manage legitimate apprehension.

Both eyes have surgery in the same operative session in case of PRESBYLASIK, 2 to 8 days apart in case of multifocal intra ocular lens. The procedure is fully painless. The patient is discharged one hour later and should be taken home back by a relative. Driving is not permitted the day of surgery.

8/ Is surgery risky?

Presbyopia refractive surgery is extremely safe, provided common sense rules are respected, rules that I have been uncompromisingly following during all my practice: rigorous and appropriate patient selection with absolute respect of all contraindications, use of last generation measurement devices and lasers, operating rooms with highest security standards.

Side effects may happen in the following weeks or months (glare, vision fluctuation, halos); usually minor and impermanent, they do not impact final visual result, even if rarely a touch up may be needed. Surprisingly surgery is less risky than contact lens wearing, especially in terms of infectious risk. This type of surgery has now a long follow-up and has demonstrated its maturity and safety.

9/ Is there any pain after surgery? What is the visual recovery time?

Presbyopia surgery causes more discomfort than true pain; visual rehabilitation is fast, taking several hours to one day.

10/ Which are the prohibited activities after surgery?

Resume work and driving are fully permitted the day after surgery. Both are one week delayed after PRK. Swimming and combat sports should not be practiced during a month regardless the technique.

Make-up is permitted after a week, as well as sun exposure, provided sunglasses are worn.

Rehabilitation is therefore extremely fast, for patient major happiness and satisfaction.

FAQ Presbyopia

1/ Can surgery be truly performed upon presbyopia?

Yes, on more and more patients, especially if they have a concomitant refractive error (myopia, astigmatism, hyperopia), for this error is corrected as the same time.

Surprisingly surgery is the least often performed on patients with perfect distance uncorrected visual acuity, for near vision restoration can sometimes alter distance vision quality.

However it may be useful to perform surgery on unstable hyperopia, in cases of particular professional requests (entry into the army, police, and so on); in such cases secondary optic correction will be necessary and reoperation considered after hyperopic stability achievement.

2/ At what age is surgery recommended?

No there is no inferior or upper limit. It's not so much the age that counts as the spectacles dependance as well as a refractive error at distance vision. Nevertheless surgery shoud usually not be performed before 48 – 50 years of age.

However age and potential concomitant presbyopia may influence surgical feasibility as well as the choice of the surgical technique.

3/ Are all patients suitable for surgery?

No, there are several contraindications. It is the main purpose of preoperative consultation to detect and eliminate unappropriate candidates.

Some patients are not operable at all; others are only eligible for specific techniques. Therefore your surgeon must have the ability to indifferently perform all surgical procedures in order to let you benefit from the most appropriate one.

4/ Is the visual result stable with time?

It depends on the type of the procedure and the age of the patient. The visual result is stable for all life long with multifocal intra ocular lenses, but these lenses cannot be inserted inside the eye before 50 years of age. With PRESBYLASIK, normal presbyopia progression with time may counteract the initial result; a secondary procedure may be needed a decade later, either by an excimer laser touch up, or by the insertion of a multifocal intra ocular lens.

5/ How long should the contact lenses should be removed before surgery?

Contact lens removal is mandatory 48 hours before surgery in case of soft contact lenses, 1 month in case of rigid contact (it is possible to temporarily replace them by soft ones which will be removed 48 hours before surgery).

6/ Is it possible to perform presbyopia surgery at the same time?

In most cases yes, insomuch hyperopia decompensates and becomes bothering at age of presbyopia.

7/ How is surgery performed?

Surgery is performed under local anaesthesia, by anaesthetic drops instillation. In contrary to popular belief there is no injection in the eye. Oral sedation is given two hours prior to surgery, in order to manage legitimate apprehension.

Both eyes have surgery in the same operative session in case of PRESBYLASIK, 2 to 8 days apart in case of multifocal intra ocular lens. The procedure is fully painless. The patient is discharged one hour later and should be taken home back by a relative. Driving is not permitted the day of surgery.

8/ Is surgery risky?

Presbyopia refractive surgery is extremely safe, provided common sense rules are respected, rules that I have been uncompromisingly following during all my practice: rigorous and appropriate patient selection with absolute respect of all contraindications, use of last generation measurement devices and lasers, operating rooms with highest security standards.

Side effects may happen in the following weeks or months (glare, vision fluctuation, halos); usually minor and impermanent, they do not impact final visual result, even if rarely a touch up may be needed. Surprisingly surgery is less risky than contact lens wearing, especially in terms of infectious risk. This type of surgery has now a long follow-up and has demonstrated its maturity and safety.

9/ Is there any pain after surgery? What is the visual recovery time?

Presbyopia surgery causes more discomfort than true pain; visual rehabilitation is fast, taking several hours to one day.

10/ Which are the prohibited activities after surgery?

Resume work and driving are fully permitted the day after surgery. Both are one week delayed after PRK. Swimming and combat sports should not be practiced during a month regardless the technique.

Make-up is permitted after a week, as well as sun exposure, provided sunglasses are worn.

Rehabilitation is therefore extremely fast, for patient major happiness and satisfaction.

WEARING GLASSES AND/OR CONTACT LENSES IS NOT ANYMORE A FATALITY


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YOU ARE SUFFERING
FROM MYOPIA

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YOU ARE SUFFERING
FROM HYPEROPIA

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YOU ARE SUFFERING
FROM PRESBYOPIA

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YOU ARE SUFFERING
FROM ASTIGMATISM

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SCHEDULE YOUR APPOINTMENT WITH DR. WEISER


PRACTICE

61 rue de Rennes
75006 Paris

Phone : +33 (0)1 45 48 31 13

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Phone : +33 (0)1 58 05 20 00

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astigmate paris ophtalmologie

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This site only presents information on anterior segment surgeries, such as refractive, cataract, and glaucoma surgery. It does not include advertising. It refers only to recognized methods, proven by a vast majority of specialists. Its contents may not be exhaustive as recommended by the French administration. The responsibility of the website solely belongs to his author, Marc Weiser, M.D. Our privacy policy.

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