Surface laser surgery for presbyopia, ideal for thin corneas and athletes, in Paris, with Dr Gozlan.
Presby-PRK is a well-established technique for laser eye surgery to correct presbyopia when Presby-LASIK is not suitable. Performed on the surface of the cornea, without creating a flap, it restores comfortable near vision while being particularly well suited for thin corneas and for individuals exposed to eye trauma. Dr Gozlan, an ophthalmic surgeon holding a University Diploma in Refractive Surgery and Phacoemulsification (University of Toulouse), explains the principle, optical strategies, indications, procedure, recovery, results, risks, and cost of this surgery.
Presby-PRK is a variant of PRK (photorefractive keratectomy) specifically designed to correct presbyopia. Unlike Presby-LASIK, it does not create a corneal flap : the thin layer of surface cells on the cornea, known as the epithelium, is gently removed, and then the excimer laser reshapes the corneal surface. The difference from a standard PRK lies in the sculpted profile : the laser shapes a multifocal cornea or applies micro-monovision to restore near vision. The epithelium regenerates naturally within a few days. The procedure takes approximately ten minutes per eye and is performed on an outpatient basis.
Presbyopia is a natural change in the eye. With age, the crystalline lens loses its flexibility and the eye can no longer accommodate, meaning it can no longer focus on nearby objects. Reading and screens become blurry, and you instinctively hold text further away to see it more clearly. Presbyopia typically begins around age 45 and progresses until approximately age 60. Presby-PRK does not rejuvenate the crystalline lens : it modifies the optics of the corneal surface to compensate for this loss of accommodation.
Like Presby-LASIK, Presby-PRK restores near vision using two approaches, sometimes combined :
The choice depends on your lifestyle, the degree of presbyopia, and your tolerance to micro-monovision, which is assessed during the preoperative workup, sometimes after a trial with contact lenses.
Presby-PRK increases the eye's depth of focus : the range of distances seen clearly is widened. This improvement comes with a period of brain adaptation (neuroadaptation), during which the brain learns to select the correct image depending on the viewing distance ; it takes a few days to a few weeks and here overlaps with surface healing.
During the same session, Presby-PRK also corrects myopia (nearsightedness), hyperopia (farsightedness), or astigmatism associated with presbyopia. The goal is clear near and distance vision without glasses or contact lenses for most activities. These refractive errors and their laser correction are discussed in detail on the dedicated myopia surgery website.
Presby-PRK is intended for presbyopic patients who wish to free themselves from reading glasses and whose vision is stable. It is especially recommended :
For very advanced presbyopia or a lens that is becoming cloudy, lens replacement surgery may be preferable. Only the preoperative workup can determine the safest technique.
No procedure is performed without a thorough, painless preoperative workup. Before Presby-PRK, it includes :
As with any laser eye surgery, contact lenses must be removed several days to several weeks before the workup to avoid distorting the measurements.
Presby-PRK is performed on an outpatient basis, with no hospital stay, in six steps. You remain awake ; the procedure takes about ten minutes per eye.
Recovery after Presby-PRK is more gradual than after Presby-LASIK. During the 2 to 3 days of epithelial regrowth, discomfort, tearing and significant light sensitivity are common ; they are relieved by painkillers, eye drops and the bandage contact lens. Added to this is the neuro-adaptation period to multifocal vision :
Presby-PRK acts on the cornea and is suitable when the natural lens is still clear. When presbyopia is very advanced or an early cataract is developing, it may be more appropriate to replace the natural lens with a suitable implant : this is lens replacement surgery, which involves a separate care pathway. The assessment determines the most long-lasting solution based on age, prescription and the condition of the natural lens.
Presby-PRK and Presby-LASIK correct presbyopia using the same optical principle, but Presby-PRK works on the surface while Presby-LASIK operates beneath a flap. The difference is mainly felt during recovery : longer and somewhat uncomfortable in the first few days with Presby-PRK, very rapid with Presby-LASIK. In return, the absence of a flap makes Presby-PRK safer for thin corneas and impact-prone activities.
Presby-PRK delivers long-term results equivalent to those of Presby-LASIK for near vision : the majority of patients can once again read without glasses for everyday activities, while maintaining good distance vision (literature reviews on corneal multifocality, Eye, 2023 ; Arba Mosquera & Verma, Eye and Vision, 2017). The result is stable but does not prevent subsequent ageing of the natural lens. Careful candidate selection is key to patient satisfaction.
Surface laser eye surgery is safe and well-established. Risks are rare and most often temporary :
Careful screening for contraindications and a thorough preoperative assessment reduce these risks to a minimum.
Presby-PRK is not performed in the presence of : progressive keratoconus, unstable refraction, significant cataract, severe dry eye, or certain corneal or autoimmune diseases. In cases of cataract or very advanced presbyopia, lens replacement surgery is often preferable.
The absence of a corneal flap makes Presby-PRK the technique of choice for contact-sport athletes (boxing, rugby, martial arts) and professionals exposed to eye injuries (firefighters, military personnel, law enforcement), where a flap could theoretically shift upon impact. This is one of the major advantages of Presby-PRK over Presby-LASIK for these presbyopia profiles.
Like Presby-LASIK, the procedure is not covered by public health insurance as it is considered an elective treatment. Many private health insurance plans offer a "laser eye surgery" allowance covering all or part of the procedure. The cost depends on the correction needed and the technique used ; a transparent quote is provided at your preoperative consultation, with no obligation.
The procedure itself is painless (topical anesthetic eye drops). However, during the 2 to 3 days of epithelial regrowth, discomfort, tearing, and light sensitivity are common; analgesics and a bandage contact lens provide relief.
Yes, that is its goal. The laser gives the cornea a multifocal profile or applies micro-monovision to restore near vision while preserving distance vision. Most patients can manage without reading glasses in daily 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 performed during the assessment, sometimes using contact lenses.
Recovery is more gradual than after Presby-LASIK: functional vision returns within a few days, then sharpens over 2 to 4 weeks. In addition, the brain needs time to adapt to multifocal vision.
Presby-PRK is preferred when the cornea is too thin for a flap, in cases of irregular cornea, or for contact-sport athletes and professions exposed to ocular trauma, because no flap is created.
Yes. Presby-PRK corrects presbyopia and, in the same session, any associated myopia, astigmatism, or hyperopia (farsightedness).
It is a faint scarring opacity that may appear on the surface. Now rare, it is prevented by the application of mitomycin C during the procedure and by adequate sun protection in the following weeks.
Presbyopia results from the aging of the crystalline lens, which continues over time. The surface correction provides lasting relief from near-vision difficulty; if the lens becomes cloudy with age (cataract), lens replacement surgery can take over.
Work can usually be resumed 3 to 7 days after Presby-PRK. Non-contact sports after one week, swimming and combat sports after 2 to 3 weeks.
Presby-PRK is intended for presbyopic patients, most often from age 45–50, whose refraction is stable. When the crystalline lens is already significantly affected, lens replacement surgery may be preferable.
No, like all refractive surgery for presbyopia, it is not covered by the French national health insurance (Assurance Maladie). Many supplemental 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, evaluates your eligibility for Presby-PRK during a comprehensive assessment and determines with you the technique best suited to your eyes.
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