The presbyopia debate

During the “Controversies in Cataract and Refractive Surgery” symposium, Dr Jack Holladay and Dr Theo Seiler debated the relative merits of presbyopia treatments.

Dr Holladay argued that the ACI7000 corneal inlay (Acufocus, Inc.), which utilizes the pinhole effect to reduce the pupil size to 1.6 mm, improves the depth of field without impacting the cornea, and cited the initial 41 Acufocus implantations in Turkey; two years later, patients have 20/16 vision at near and distance, and the operating surgeon is satisfied with the results.

Dr Seiler countered by discussing the cosmetic and low light issues some patients have had with the Acufocus. He noted that we assume that what we know about the multifocality or asphericity of IOLs also holds true for the cornea. He mentioned several advantages of the aspheric hyperprolate cornea but observed that this is not a bilateral solution; he dismissed bifocal refractive treatments as there is limited prospective data, they are irreversible, and dissatisfaction is high. Monovision, he concluded, is currently the only clinically accepted approach.

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