Presbyopia Correction in Lens Replacement Surgery: A Review

Abstract

Presbyopia affects approximately 1.8 billion individuals globally, posing significant challenges as life expectancy and near-vision demands, particularly with mobile phone use, grow. Addressing presbyopia during lens replacement surgery has become a key focus for cataract surgeons, aiming to reduce dependence on corrective eyewear. This review provides an overview of current intraocular lens (IOL) technologies and surgical strategies for presbyopia correction. Personalised decision-making is essential, considering each patient's visual needs, expectations, and ocular anatomy. Partial correction approaches, such as monovision and extended depth-of-focus IOLs, can improve intermediate vision but involve specific trade-offs compared to monofocal lenses, depending on the technology utilised. For complete presbyopia correction, multifocal IOLs remain the most effective option. A mix-and-match strategy involving unilateral multifocal implantation shows promise, while sulcus-fixated supplementary IOLs offer the advantage of easier reversibility. Careful IOL selection is particularly important for patients with atypical ocular anatomy or coexisting conditions, which may be progressive.

Keywords: cataract; extended depth‐of‐focus lenses; monovision; multifocal intraocular lenses; presbyopia.

FIGURE 1

Wavefront and vergence representation for −0.3 μm Zernike spherical aberration (SA) for a 6 mm pupil diameter. The left map shows the wavefront of a −0.3 μm Zernike SA, exhibiting a sombrero‐like shape with central depression and peripheral elevation. While this micron‐scale representation lacks direct refractive interpretation, the right vergence map (in diopters) illustrates the refractive effect: Central myopisation (−0.88 D) transitioning to peripheral hyperopisation (+0.88 D). This negative SA results in a progressive optical power reduction from centre to periphery, corresponding to a ~2 D decrease across the pupil. This gradual shift enhances depth of field while minimising defocus for distance vision.

FIGURE 2

Diffractive step profiles provided by the NIMO TEMPO (Lambda‐X, Nivelles, Belgium) from the wavefront measurements of the multifocal lens FineVision HP (BVI) and the diffractive EDOF AT LARA 829 (Zeiss). The profile shows that the AT LARA has wider steps, resulting in a lower addition to the lens. However, the steps are also higher, which enhances light diffraction and intends to correct for chromatic aberration.