PresbyLASIK: A review of PresbyMAX, Supracor, and laser blended vision: Principles, planning, and outcomes

Abstract

PresbyLASIK is one of the most commonly used modalities of surgical correction in presbyopes with no cataract. Unlike monovision procedures, both the eyes are adjusted for near and distance, providing a good stereopsis. This works by creating a corneal multifocality and increasing the depth of focus. Most techniques of presbyLASIK currently employ hybrid methods, i.e., a component of monovision added on to a multifocal corneal ablation. Choosing an appropriate proportion of these two components according to the patients' requirements and meticulous patient selection are key to obtaining desirable outcomes. Being corneal-based procedures, presbyLASIK has shown to be reversible. Thorough updated knowledge of the different presbyLASIK procedures, their principles and outcomes based on previous studies is required before a refractive surgeon plans to start providing presbyLASIK services. We performed a comprehensive search on PubMed with the keywords "Presbyopia surgery," "PresbyLASIK" "PresbyMAX," "Supracor," and "Custom-Q." In this review article, we have explained the principles of the various presbyLASIK procedures, appropriate patient selection and planning on the devices with examples, and summarized the previously published outcomes of these techniques.

Keywords: Laser blended vision; PresbyLASIK; PresbyMAX; Supracor.

Figure 1

A broad classification of static surgical approaches in the management of presbyopia

Figure 2

A broad classification of PresbyLASIK approaches

Figure 3

PresbyMAX hybrid planning in the dominant eye. OD is the dominant eye. Note that OD is corrected for distance with an additional paracentral corneal ablation, creating a central hyperprolate area enhancing the depth of focus

Figure 4

PresbyMAX hybrid planning in the nondominant eye. OS is targeted to -0.89D target refraction with an additional paracentral corneal ablation, creating a central hyperprolate area enhancing the depth of focus

Figure 5

Supracor planning. OD, the dominant eye is aimed for -0.5D myopia along with mild supracor which causes additional paracentral ablation to create an intermediate-near zone

Figure 6

Supracor planning. OS, the nondominant eye is aimed for -0.5D myopia along with regular supracor (greater paracentral ablation compared to OD) for better near vision

Figure 7

PRESBYOND treatment planning with CRS-Master for a 50-year old male. OD is the dominant eye and the patient had full tolerance to the +1.5 D test. OD was targeted to emmetropia and OS to a myopia of -1.50 D. The software automatically calculates the desired correction by adding the spherical aberration values required to adequately increase the depth of focus of each eye