Being both nearsighted and presbyopic is an extremely common situation after the age of 45. The question of the simultaneous correction of presbyopia and myopia through laser surgery then legitimately arises. Thanks to modern Presby-LASIK and Presby-PRK techniques, it is now possible to treat these two visual defects in a single procedure, offering remarkable freedom from glasses and progressive contact lenses.
Correction of presbyopia and myopia: understanding how these two defects combine
Myopia is a disorder of distance vision: the eye, being too long, focuses images in front of the retina. Presbyopia, on the other hand, is the gradual loss of the lens's ability to accommodate, making near vision blurry from the age of 43-45. When these two anomalies coexist, the patient becomes bothered at every distance. The combined correction of presbyopia and myopia aims precisely to restore functional vision overall, both far and near, without resorting to progressive lenses.
One interesting phenomenon deserves to be highlighted: a person with mild myopia sometimes enjoys a temporary natural advantage by removing their glasses to read up close. However, this compensation disappears once presbyopia progresses beyond +2.00 diopters, making surgical correction all the more relevant.
How does the dual correction of presbyopia and myopia by Presby-LASIK work?
Presby-LASIK relies on a multifocal corneal reshaping with an excimer laser. The surgeon creates a superficial corneal flap, then sculpts the cornea according to a specific ablation profile that simultaneously corrects myopia and presbyopia. This profile creates several zones of optical power on the cornea:
- Central zone: optimized for near vision, correcting the add power linked to presbyopia;
- Peripheral zone: dedicated to distance vision, neutralizing myopia;
- Intermediate zone: a gradual transition ensuring smooth vision at all distances;
- Micro-monovision: a complementary technique where the dominant eye is set for distance and the non-dominant eye slightly for near.
This approach to the correction of presbyopia and myopia by Presby-LASIK offers rapid visual recovery, generally within 24 to 48 hours, with greater postoperative comfort than PRK.
Presby-PRK: an alternative for the correction of presbyopia and myopia on thin corneas
When corneal thickness is insufficient to create a stromal flap, Presby-PRK constitutes an excellent alternative. The excimer laser is applied directly to the surface, after mechanical removal of the corneal epithelium. The multifocal ablation profile remains identical to that of Presby-LASIK, allowing an equally effective correction of presbyopia and myopia.
The main differences lie in the recovery time, which is longer (5 to 7 days for initial visual stabilization), and in moderate postoperative discomfort during the first 48 hours. On the other hand, Presby-PRK eliminates any risk linked to the corneal flap and preserves more stromal tissue, which makes it particularly suited to moderate myopia associated with early presbyopia.
Ideal profiles for the correction of presbyopia and myopia with laser
Not all nearsighted and presbyopic patients are automatically eligible for laser surgery. A thorough preoperative assessment determines the feasibility of the procedure. The essential criteria are as follows:
- Age: between 45 and 65, the period when presbyopia is established and myopia stabilized;
- Myopia: up to about -8.00 diopters, depending on the available corneal thickness;
- Presbyopia: an add power of +1.50 to +3.00 diopters;
- Corneal thickness: greater than 500 µm for Presby-LASIK, with the possibility of Presby-PRK below that;
- Absence of pathology: no keratoconus, advanced glaucoma or significant cataract.
Topographic and aberrometric assessment, along with precise pupillometry measurement under scotopic conditions, are essential to plan an optimal correction of presbyopia and myopia.
What results can be expected with the laser correction of presbyopia and myopia?
Clinical studies and the experience accumulated in multifocal refractive surgery demonstrate very satisfactory results. After a combined correction of presbyopia and myopia, patients obtain on average:
- Distance vision: 8 to 10/10 without correction in more than 90% of cases;
- Near vision: Parinaud 2 to 3 without glasses for the vast majority of patients;
- Freedom from glasses: more than 85% of those operated on no longer wear correction in daily life;
- Overall satisfaction: higher than 90% in published series.
It is important to note that the laser correction of presbyopia and myopia does not prevent the natural progression of presbyopia with age. A laser touch-up is sometimes possible if the add power increases significantly after a few years.
Risks and limits of the combined correction of presbyopia and myopia
Like any surgery, combined refractive correction carries risks, although they are rare and mostly transient. Potential side effects include temporary dry eye, nighttime light halos and slight visual fluctuation during the period of cerebral neuroadaptation, which generally lasts one to three months.
The true contraindications to the laser correction of presbyopia and myopia remain subclinical keratoconus, a cornea too thin even for PRK, an early cataract that rather justifies replacing the lens with a multifocal implant, or unrealistic patient expectations. The preoperative dialogue with the surgeon is fundamental to define realistic goals and choose the best strategy.
When to consult Dr Gozlan for the correction of presbyopia and myopia?
The initial consultation is recommended as soon as the visual discomfort linked to the myopia-presbyopia combination impacts your daily quality of life: difficulty switching between screen and distance vision, visual fatigue at the end of the day, discomfort with progressive lenses. The complete assessment carried out by Dr Gozlan makes it possible to determine whether you are a good candidate for the correction of presbyopia and myopia by laser and which technique — Presby-LASIK or Presby-PRK — is best suited to your corneal anatomy.
📍 Consultation at the Paris – Auteuil Ophthalmology Practice
Dr Gozlan, ophthalmic surgeon specialized in refractive surgery for presbyopia at the Paris – Auteuil Ophthalmology Practice, welcomes you for your assessment and treatment.
Book an Appointment on DoctolibFAQ: correction of presbyopia and myopia — frequently asked questions
Is the laser correction of presbyopia and myopia permanent?
The correction of myopia is permanent because the axial length of the eye no longer changes in adulthood. Presbyopia, on the other hand, can continue to evolve slightly over time. A laser touch-up is possible if necessary, provided there is sufficient residual corneal thickness.
Can myopia and presbyopia be corrected on both eyes on the same day?
Yes, in the vast majority of cases, the correction of presbyopia and myopia is performed bilaterally and simultaneously. This approach allows faster cerebral adaptation to the multifocal profile and reduces the number of postoperative appointments.
How long does the procedure for the correction of presbyopia and myopia take?
The procedure lasts about 15 to 20 minutes for both eyes. The laser treatment itself takes only a few seconds per eye. The whole process, from arrival to discharge, represents about one hour.
Is the correction of presbyopia and myopia covered by national health insurance?
Refractive surgery is considered an elective procedure and is not reimbursed by national health insurance. Some private health plans, however, offer an annual allowance for laser surgery. It is advisable to check your contract before the procedure.
From what age can the correction of presbyopia and myopia be considered?
The combined correction is generally offered from the age of 45-47, when presbyopia is sufficiently established to justify a multifocal treatment. Before that age, a simple LASIK for myopia alone is preferable.
Further reading
- Presby-LASIK: the most widespread multifocal technique for presbyopia;
- Presby-PRK: an alternative for thin corneas;
- Presby-LASIK vs Presby-PRK comparison: all the differences explained.