Treatment and correction of presbyopia

The treatment and correction of presbyopia continues to be a key area of clinical research, innovation and refinement in the field of refractive and cataract surgery. Accommodative solutions for presbyopia include the implantation of accommodating IOLs or the recovery of natural accommodation via sclera and lens manipulations.

However, the true mechanism of accommodation remains to be fully understood and real accommodative solutions are still under scientific investigation. Pseudoaccommodative techniques include the use of multifocal IOLs, pinhole and corneal inlays, or multifocal corneal approaches using excimer and femtosecond lasers.

An excimer-based technique

I have used a number of excimer-based approaches for treating presbyopia during the past 15 years. However, with these solutions, although providing the required multi-focality to afford psuedoaccommodation, there can be a compromise between achieving the optimal near and distance vision outcomes, which can lead to the induction of additional undesired aberrations within the pupil region. These unwanted aberrations can be caused by the surgically induced spherical aberrations or created by combining the near treatment with the distance correction, causing an overlap of the optical zones and transition zones. Overall, these aberrations can cause a loss of distance vision or quality of vision.

A new excimer-based algorithm, known as SUPRACOR, has been developed by Technolas Perfect Vision (TPV), which is designed to provide the near addition for treating presbyopia, while minimizing the induction of any undesired aberrations within the pupil region. This aberration-optimized presbyopic algorithm can be applied to a broad range of presbyopic patients, and may also be suitable for post-LASIK candidates as well. This treatment benefits from being a bilateral LASIK treatment approach, with the same profile applied to both eyes so there is no monovision. SUPRACOR can be performed on either the TECHNOLAS 217P or any TECHNOLAS excimer laser operating at 100 Hz and equipped with APT and the Advanced Control Eyetracking (ACE) technology.

Significant improvement in near vision

High level of Patient satisfaction

Effective and safe solution

As with all procedures, successful patient outcomes with the SUPRACOR procedure require a combination of both the right treatment algorithm and laser equipment and as well as appropriate patient management from the surgeon and clinic staff. Thorough patient selection, education and management should be applied preoperatively and postoperatively.

Further longer term follow-up data is required to confirm the stability of these outcomes, but according to the current data available, SUPRACOR certainly appears to provide an effective and safe solution to presbyopia, avoiding the previously reported compromises experienced with other excimer based algorithms, such as diminished distance vision. Because it is a bilateral treatment, it avoids any compromises associated with monovision. Furthermore, the treatment offers the option for easy enhancement and has the potential to be applied to post-LASIK patients. The SUPRACOR procedure received CE Mark approval in May 2011.

Dr Dominique Pietrini is an ophthalmologist at the Clinique de la Vision, Paris, France. He may be reached by E-mail: docteurpietrini@gmail.com

Dr Pietrini has indicated no financial interests in the subject matter of this article