Surface presbyopia surgery, ideal for thin corneas and athletes, in Paris, with Dr Gozlan.
Presby-PRK is a gold-standard technique for laser presbyopia surgery when Presby-LASIK is not indicated. Performed on the surface of the cornea, without creating a flap, it restores comfortable near vision while being particularly well suited to thin corneas and individuals exposed to ocular trauma. Dr Gozlan, ophthalmic surgeon holding a University Diploma in Refractive Surgery and Phacoemulsification (University of Toulouse), explains the principle, optical strategies, indications, procedure, postoperative course, results, risks and cost of this surgery.
Presby-PRK is a variant of PRK (photorefractive keratectomy) dedicated to the correction of presbyopia. Unlike Presby-LASIK, it does not create a flap : the thin layer of surface cells on the cornea, the epithelium, is gently removed, and then the excimer laser reshapes the corneal surface. The difference from 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 evolution of the eye. With age, the crystalline lens loses its flexibility and the eye can no longer accommodate, i.e. focus at close range. Reading and screens become blurry, and texts are instinctively held further away to see better. Presbyopia 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 lifestyle, the degree of presbyopia, and tolerance to micro-monovision, assessed during the preoperative evaluation, sometimes after a trial with contact lenses.
Presby-PRK increases the depth of field of the eye : the range of distances seen in focus is widened. This gain is accompanied by a period of brain adaptation (neuroadaptation), during which the brain learns to select the correct image based on the viewing distance ; this takes a few days to a few weeks and here overlaps with surface healing.
During the same session, Presby-PRK also corrects any associated myopia, hyperopia, or astigmatism alongside presbyopia. The goal is clear near and distance vision without correction for most activities. A detailed description of these refractive errors and their laser correction is available on the dedicated myopia surgery website.
Presby-PRK is intended for presbyopic patients wishing to free themselves from reading glasses, whose vision is stable. It is particularly recommended :
For very advanced presbyopia or a crystalline lens that is becoming opaque, crystalline lens surgery may be preferable. Only the preoperative assessment determines the safest technique.
No procedure is performed without a thorough and painless pre-operative assessment. Before Presby-PRK, it includes :
As with any refractive surgery, contact lenses must be removed several days to several weeks before the assessment to avoid distorting the measurements.
Presby-PRK is performed on an outpatient basis, without hospitalisation, in six steps. You remain awake ; the procedure takes approximately 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 analgesics, eye drops and the bandage contact lens. To this is added the time required for neuro-adaptation to multifocal vision :
Presby-PRK acts on the cornea and is suitable when the crystalline lens is still clear. When presbyopia is very advanced or an early cataract is developing, it may be more appropriate to replace the crystalline lens with a suitable intraocular lens implant : this is crystalline lens surgery, which involves a separate management pathway. The pre-operative assessment guides the patient towards the most durable solution based on age, refractive error and the condition of the crystalline lens.
Presby-PRK and Presby-LASIK correct presbyopia using the same optical principle, but Presby-PRK acts on the surface while Presby-LASIK works 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. On the other hand, 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 level of evidence remains moderate, however (primarily case series) : partial regression and a slight decrease in contrast sensitivity are possible over time. The result is stable but does not prevent subsequent crystalline lens aging. Careful candidate selection is key to patient satisfaction.
Surface surgery is safe and well-established. Risks are rare and most often transient :
Adherence to contraindications and the quality of the 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, certain corneal or autoimmune diseases. In cases of cataract or very advanced presbyopia, crystalline lens surgery is often preferable.
The absence of a flap makes Presby-PRK the technique of choice for contact sports athletes (boxing, rugby, martial arts) and professions exposed to ocular trauma (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 presbyopic profiles.
Like Presby-LASIK, the correction is not covered by national health insurance as it is considered an elective procedure. Many supplementary health insurance plans offer a "refractive surgery" package covering all or part of the procedure. The cost depends on the correction and the technique ; a transparent quote is provided during the preoperative consultation, with no obligation.
The procedure itself is painless (topical anaesthesia with 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 no longer need 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 refines 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.
It is a faint scarring opacity that may appear on the surface. Now rare, it is prevented by applying mitomycin C during the procedure and by adequate sun protection in the following weeks.
Presbyopia results from ageing of the crystalline lens, which continues over time. The surface correction provides long-lasting relief from near-vision difficulty; if the lens becomes cloudy with age (cataract), crystalline lens surgery can take over.
Work can generally 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 the age of 45–50, whose refraction is stable. When the crystalline lens is already significantly aged, lens surgery may be preferable.
No, like all refractive surgery for presbyopia, it is not covered by the French national health insurance (Assurance Maladie). Many supplementary insurance plans offer a dedicated allowance covering all or part of the procedure.
As holder of the University Diploma in Refractive Surgery and Phacoemulsification, Dr Gozlan 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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