Why are you holding the page further away these days?
Presbyopia is a gradual loss of the eye's ability to focus on near objects, caused by the eye's natural lens stiffening with age. It is usually first noticed in the mid-40s and keeps progressing into the mid-50s, and it happens to almost everyone, including people who have already had successful laser vision correction.
What is happening to your eyes after 40 is not a disease and not a sign of damage. This page explains what has changed, what the options actually are, the corneal route and the lens route, and where each one's limits are.
Why choose us
International standard. Regional access.
The exam decides the route, not preference
The right route for you is not chosen by preference or by price. It is chosen by the state of your cornea, the state of your own natural lens, and your refraction. No page on the internet can determine that. An exam can.
Two genuinely different routes
Either the cornea's surface is reshaped with a laser while your natural lens stays exactly where it is, or your natural lens is replaced with an intraocular lens. The difference between the two is not price, it is the state of your natural lens and your age.
A trial before any irreversible step
Before any surgical decision that relies on a deliberate difference between your two eyes, our practice is to have you trial the same setup with contact lenses for a period, so you find out for yourself whether you are comfortable with it.
Reading glasses are a legitimate choice
Staying with reading glasses is a sound medical decision, not a failure and not a delay. For many people, after the exam, the right answer turns out to be no surgery at all.
Two routes to correct near vision
We offer two routes, and the difference between them is not price and not personal preference. It comes down to two questions: is your own natural lens still clear, and how old are you, which is really a question of how long it is likely to stay clear.
| Criterion | Corneal route (laser) | Lens route (intraocular lens) |
|---|---|---|
| What changes | The cornea's surface is reshaped with a laser, your natural lens stays where it is | Your natural lens is removed and an intraocular lens that corrects near vision is implanted |
| State of your natural lens | Needs to still be clear | Makes sense once it has started to cloud |
| When it makes sense | A younger patient who wants to postpone any surgery inside the eye | An older patient who will need lens surgery within a few years regardless |
| If a cataract develops later | You will still need lens surgery, and IOL power calculation is harder on a cornea already reshaped by laser | Does not apply, the natural lens has already been replaced |
| Reversibility | A permanent change to corneal tissue, effectively not reversible | The lens can, in theory, be exchanged, but that is its own surgery with its own risks |
| Visual trade-off | Reduced distance sharpness in the eye set for near, and reduced depth perception | Halos, night glare, and reduced contrast with multifocal designs |
The lens route is explained in more detail on our premium IOL guide, and the laser route on our laser vision correction page.
Monovision: what it is, and where it can go wrong
In monovision, one eye, usually the dominant one, is set for distance, and the other eye is left or set for near, so the brain relies on whichever eye suits each distance. Many people who adapt to it stop noticing it within weeks.
Three things you should know before agreeing to it:
First, it is a trade-off, not a free upgrade. The medical literature documents that it reduces stereo depth perception and binocular contrast quality when using both eyes together.
Second, some people never adapt to it and remain uncomfortable, and no exam can reliably identify those people beforehand.
Third, and the most practically important point: because no one can predict who will adapt, our practice is to have the patient trial the target setup with contact lenses for a period before any surgical step. We offer this as a practice we prefer, to reduce surprises, not as a test with a stated predictive accuracy.
What you can honestly expect, and what you cannot
- Halos and night glare.Any correction that splits the eye's focus across more than one distance leaves this effect, most noticeable in the first few months and in low light. It fades for many people over time, but it persists for some and does not go away.
- Reduced contrast. This is the price of extending depth of focus, and it shows up most in low light, in rain, and while driving at night.
- You may still need glasses sometimes. For very small print, for long reading sessions, or for reading in low light. The realistic goal is reduced dependence on glasses, not its elimination.
- The condition keeps progressing after surgery. Presbyopia continues progressing until roughly the mid-50s, so the correction targets a moving condition. A result that satisfies you today may not satisfy you in ten years, and further correction then is not guaranteed.
- There are no outcome numbers for this procedure on this page. You will not find a success rate, a satisfaction percentage, or a patient count here, because publishing a number with no documented case series behind it would be misleading. Ask what applies to your own case at your consultation.
When surgery is a bad idea in your case
This is not a formality. Every item here is a real reason to decline or postpone, and every item is written with its reason attached:
- Untreated dry eye. Laser surgery on the cornea temporarily worsens dryness, and a weaker tear film degrades the very image quality the correction depends on. Treat first, re-evaluate, then decide.
- Keratoconus, or a suspicious topography. Abnormal corneal imaging is the strongest single warning sign for corneal weakening after laser surgery. This is a full stop, not a reason for caution. The keratoconus pathway is a different route entirely.
- A thin cornea. The amount of tissue altered is linked to the risk of later corneal weakening, even in eyes with normal imaging. These patients are routed to a different technique.
- Uncontrolled systemic disease. Uncontrolled diabetes, active autoimmune disease, and immune suppression, because of impaired healing and higher infection risk.
- Unrealistic expectations. A patient who wants a guarantee of never touching glasses again should be told no, not sold to. That is a reason we decline surgery here, not a reason to persuade someone.
- A natural lens that has already started clouding. A corneal laser is the wrong procedure here: it will not stop the lens from clouding further, and lens surgery will be needed within a few years regardless.
- Cases needing special evaluation: refraction not stable over the last year, pregnancy and nursing, and prior eye surgery.
What does the assessment involve?
Baseline eye exam
- Corneal topography and tomography (Pentacam)
- Corneal thickness measurement
- OCT imaging
- Retinal and posterior-segment evaluation
- Pupil measurement
- Refraction, confirmed stable for at least a year
- Dry-eye assessment: tear break-up time and Schirmer's test
Presbyopia-specific steps
- Near vision measured at your own actual working distance, not a standard one
- Determining your dominant eye
- Assessing how clear your natural lens still is
- If monovision is being considered, trialing the setup with contact lenses first
The exam typically takes 30 to 45 minutes. Contact lenses need to be stopped a week or two beforehand so the cornea returns to its natural shape, otherwise the measurements will not be accurate.
After the procedure: distance vision usually stabilizes before near vision does, and the balance settling between your two eyes takes longer. We advise patients not to judge their result in the first weeks, and follow-up extends past the third month, because presbyopia itself continues progressing with age.
Common questions
Frequently asked.
What exactly is presbyopia?
Am I too old for these procedures?
Is the procedure painful?
Will I be completely free of glasses?
What are halos and night glare, and do they go away?
What is monovision, and does everyone adapt to it?
How long is recovery, and when should I judge the result?
Can the procedure be reversed if I am not comfortable with it?
What if my vision worsens later, or my presbyopia keeps progressing?
Is surgery better than reading glasses?
What is the difference between hyperopia and presbyopia?
Do you offer corneal inlays or presbyopia eye drops?
How much does presbyopia correction cost?
You do not need to decide today.
The next step is an exam that clarifies your own situation, not an appointment to schedule a procedure. Ask about everything on this page during it.
Medical references
- Charman WN. "The eye in focus: accommodation and presbyopia." Clin Exp Optom. 2008;91(3):207-225. Mechanism and age course.
- Glasser A, Campbell MCW. "Biometric, optical and physical changes in the isolated human crystalline lens with age in relation to presbyopia." Vision Res. 1999;39(11):1991-2015. Lens stiffening as the cause.
- Anderson HA, Hentz G, Glasser A, Stuebing KK, Manny RE. "Minus-lens-stimulated accommodative amplitude decreases sigmoidally with age." Invest Ophthalmol Vis Sci. 2008;49(7):2919-2926. Continued decline in focusing power with age.
- Fricke TR, Tahhan N, Resnikoff S, et al. "Global prevalence of presbyopia and vision impairment from uncorrected presbyopia." Ophthalmology. 2018;125(10):1492-1499. How common the condition is worldwide.
- Gil-Cazorla R, Shah S, Naroo SA. "A review of the surgical options for the correction of presbyopia." Br J Ophthalmol. 2016;100(1):62-70. Reviews the corneal route and the lens route together.
- Arba Mosquera S, Alió JL. "Presbyopic correction on the cornea." Eye Vis (Lond). 2014;1:5. Limits of corneal correction and its effect on contrast.
- Alió JL, Grzybowski A, Romaniuk D. "Refractive lens exchange in modern practice: when and when not to do it?" Eye Vis (Lond). 2014;1:10. When lens exchange is not the right decision.
- Jain S, Arora I, Azar DT. "Success of monovision in presbyopes: review of the literature and potential applications to refractive surgery." Surv Ophthalmol. 1996;40(6):491-499. Variable adaptation to monovision.
- Evans BJW. "Monovision: a review." Ophthalmic Physiol Opt. 2007;27(5):417-439. Loss of stereo depth perception and contrast quality with monovision.
- Randleman JB, Woodward M, Lynn MJ, Stulting RD. "Risk assessment for ectasia after corneal refractive surgery." Ophthalmology. 2008;115(1):37-50. Abnormal topography as the strongest risk factor.
- Santhiago MR, Smadja D, Gomes BF, et al. "Association between the percent tissue altered and post-LASIK ectasia in eyes with normal preoperative topography." Am J Ophthalmol. 2014;158(1):87-95. Thin corneas and tissue-altered risk.
- Gomes JAP, Azar DT, Baudouin C, et al. "TFOS DEWS II iatrogenic report." Ocul Surf. 2017;15(3):511-538. Dry eye linked to refractive surgery.
- de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. "Multifocal versus monofocal intraocular lenses after cataract extraction." Cochrane Database Syst Rev. 2016;12:CD003169. Better near vision against more glare and halos.
- Kamiya K, Hayashi K, Shimizu K, Negishi K, Sato M, Bissen-Miyajima H. "Multifocal intraocular lens explantation: a case series of 50 eyes." Am J Ophthalmol. 2014;158(2):215-220. Cases where intolerance led to lens exchange.
- Rosa AM, Miranda ÂC, Patrício MM, et al. "Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses." J Cataract Refract Surg. 2017;43(10):1287-1296. Brain adaptation takes months.
- American Academy of Ophthalmology. Refractive Errors and Refractive Surgery Preferred Practice Pattern. Reference framework for surgical contraindications.