Restore near vision without glasses using laser treatment in Paris with Dr Gozlan — myopia, astigmatism and hyperopia corrected at the same time.
Presby-LASIK is now a gold-standard technique for laser presbyopia surgery. Painless and fast, it restores comfortable near vision for the vast majority of patients without sacrificing distance vision : reading glasses become a thing of the past, or very nearly so. Dr Gozlan, ophthalmic surgeon holding a University Diploma in Refractive Surgery and Phacoemulsification (University of Toulouse), explains in detail the principle, optical strategies, indications, procedure, postoperative course, results, risks, and cost of this surgery.
Presby-LASIK is a variant of LASIK dedicated to the correction of presbyopia. Like standard LASIK, it combines a femtosecond laser, which creates a thin corneal flap, and an excimer laser, which reshapes the cornea. The difference lies in the sculpted profile : instead of a simple correction, the laser shapes a multifocal cornea or applies a micro-monovision approach, restoring the eye's ability to see clearly at multiple distances. The procedure takes approximately fifteen minutes for both eyes and is performed on an outpatient basis.
Presbyopia is not a disease but a natural evolution of the eye. With age, the crystalline lens loses its flexibility and the muscle that deforms it weakens : the eye can no longer accommodate, meaning it can no longer focus on near objects. Reading, phone use and screens become blurry, and one instinctively holds text further away to see better. Presbyopia begins around age 45 and progresses until approximately age 60. Presby-LASIK does not rejuvenate the crystalline lens : it modifies the optics of the cornea to compensate for this loss of accommodation.
To restore near vision, Presby-LASIK relies on two main approaches, sometimes combined :
The choice of strategy depends on lifestyle, the degree of presbyopia and tolerance to micro-monovision, assessed during the preoperative evaluation, sometimes after a trial with contact lenses. It is this customised optical approach that distinguishes Presby-LASIK from standard LASIK.
Presby-LASIK increases the depth of field of the eye : the range of distances seen in sharp focus is broadened. This gain is accompanied by a period of brain adaptation (neuroadaptation), during which the brain learns to select the correct image according to the viewing distance. This process takes a few days to a few weeks ; distance vision may seem slightly less "crisp" at the very beginning, before comfort sets in.
Presby-LASIK is not limited to presbyopia : during the same session, it also corrects associated myopia, hyperopia or astigmatism. Many presbyopic patients were already wearing glasses for these refractive errors ; the procedure aims to achieve clear near and distance vision without correction for most everyday activities. The details of these refractive errors and their laser correction are covered on the dedicated myopia surgery website.
The procedure is intended for presbyopic patients who are bothered on a daily basis by their dependence on reading glasses and whose vision is stable. Presby-LASIK is particularly suitable :
When the cornea is too thin, surface Presby-PRK is often preferable ; if the crystalline lens is beginning to opacify, crystalline lens surgery may be more appropriate. Only the preoperative assessment can confirm that Presby-LASIK is the safest solution for your eyes.
No procedure is performed without a thorough preoperative assessment. This painless examination lasts approximately one hour and determines the safety and quality of the outcome. It includes :
Contact lenses must be removed several days (soft lenses) to several weeks (rigid lenses) before the assessment, as they temporarily distort the cornea and compromise measurement accuracy.
Presby-LASIK is performed on an outpatient basis, in six steps. You remain awake, lying comfortably ; the procedure on both eyes takes approximately fifteen minutes.
As with LASIK, recovery is rapid. In the hours that follow, a gritty sensation, tearing, and light sensitivity are normal. Vision clears by the evening. The distinctive aspect of presbyopia surgery is the neuro-adaptation time required for multifocal vision or micro-monovision :
Presby-LASIK acts on the cornea and is suitable when the crystalline lens is still clear. When presbyopia is very advanced, after the age of 55–60, or when a cataract is developing, it may be more appropriate to replace the crystalline lens with a suitable intraocular lens implant : this is lens replacement surgery, which involves a separate treatment pathway. The preoperative assessment guides the patient towards the most durable solution based on age, refractive error, and the condition of the crystalline lens.
Presby-LASIK and Presby-PRK correct presbyopia using the same optical principle but differ in technique. With its flap, Presby-LASIK offers faster recovery and greater immediate comfort. Presby-PRK, which works on the surface without a flap, is preferred for thin corneas, contact-sport athletes, or certain high-risk occupations. In the long term, both approaches deliver equivalent results.
Literature reviews show that Presby-LASIK provides good independence from reading glasses in the majority of patients, while preserving satisfactory distance vision (systematic review, Eye, 2023 ; Arba Mosquera & Verma, Eye and Vision, 2017). The level of evidence remains moderate, however : it relies mainly on case series rather than randomized trials, and partial regression of the effect as well as a slight decrease in contrast sensitivity are possible over time. The outcome is stable but does not prevent subsequent aging of the crystalline lens : over the years, an enhancement or lens surgery may complement the management. Careful candidate selection and personalized settings are key to satisfaction.
Presby-LASIK is a safe procedure, derived from a proven technique, but like any surgical procedure it carries risks, most often minor and transient :
Adherence to contraindications and the quality of the preoperative assessment reduce these risks to a minimum.
Presby-LASIK is not performed in the presence of : keratoconus or an overly thin cornea, unstable refraction, significant cataract, severe dry eye, certain corneal or autoimmune diseases. In cases of cataract or very advanced presbyopia, lens surgery is often preferable ; in cases of a thin cornea, Presby-PRK may be offered.
Refractive surgery for presbyopia is not covered by national health insurance as it is considered an elective procedure. Many supplementary health insurance plans do, however, offer a "refractive surgery" allowance covering all or part of the procedure ; check your policy. The cost depends on the technique and the correction required ; a clear estimate is provided at the preoperative consultation, with no obligation.
No. The eye is anaesthetised with eye drops: during the procedure you feel no pain, at most a slight pressure. In the hours that follow, a gritty sensation and tearing are common but temporary.
Yes, that is its goal. By giving the cornea a multifocal profile or by applying slight micro-monovision, Presby-LASIK restores functional near vision while preserving distance vision. Most patients can manage without reading glasses in everyday life.
It is a strategy in which the dominant eye is set for distance vision and the non-dominant eye receives a slight correction for near vision. The brain combines the two images. A tolerance test is carried out during the assessment, sometimes with contact lenses, before adopting this approach.
The brain must learn to use multifocal vision or micro-monovision: this neuro-adaptation takes from a few days to a few weeks. Initially, distance vision may seem slightly less sharp, then comfort sets in.
Presbyopia results from ageing of the crystalline lens, which continues over time. The corneal correction provides lasting compensation for near-vision difficulty; if, over the years, the lens becomes cloudy (cataract), crystalline lens surgery can take over.
Yes. Presby-LASIK corrects presbyopia and, in the same session, any associated myopia, astigmatism or hyperopia. This is one of its main advantages.
The majority of patients do not experience lasting discomfort. Halos or slight night-time blur may occur in the first few weeks, inherent to multifocality, and then fade. Measuring pupil diameter during the assessment limits this risk.
No. A healthy and sufficiently thick cornea, a clear crystalline lens and stable refraction are required. In cases of cataract, very advanced presbyopia or a thin cornea, another solution (crystalline lens surgery or Presby-PRK) is preferable. The assessment decides on a case-by-case basis.
Yes, most often. Presby-LASIK is performed on both eyes during the same session, which facilitates the implementation of the strategy (multifocality or micro-monovision) and neuro-adaptation.
Presby-LASIK is intended for presbyopic patients, most commonly from 45–50 years of age, whose refraction is stable. When the crystalline lens is already significantly aged, crystalline lens surgery may be preferable.
No, refractive surgery for presbyopia is not covered by the French national health insurance (Assurance Maladie). However, many supplementary health insurance plans offer a dedicated allowance covering all or part of the procedure.
Dr Gozlan, holder of the University Diploma in Refractive Surgery and Phacoemulsification, assesses your eligibility for Presby-LASIK during a comprehensive evaluation and determines with you the technique best suited to your eyes.
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