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    Presbyopia compensation with femtosecond laser

    Corneal inlays and the Intracor technique have advantages and disadvantages

    In short: This article discusses the advantages and limitations for surgical compensation of presbyopia with the femtosecond laser using corneal inlays and the Intracor technique.

    By 2020, there will be around 2.1 billion presbyopes worldwide.1 It is unsurprising that there is a continuing interest in refractive surgical procedures that improve near vision.

    Both surgical interventions for presbyopia, and their contact lens counterparts, may reduce distance acuity, quality of vision, stereopsis or contrast sensitivity. Many also consider clear lens surgery too invasive, particularly in the early stages of the condition. Thus, there is significant interest in corneal inlays as they do not remove tissue; they preserve future options for presbyopic correction; they may be used in pseudophakia and/or combined with laser refractive surgery; they are removable; and they are only implanted within the non-dominant eye.1

    Related: Intracorneal inlays for the correction of presbyopia and low hyperopia

    There are three different corneal inlay types currently available: refractive optic inlays, which change the eye’s refractive index, providing distance vision through a plano central zone surrounded by one or more rings of varying add power for near vision; corneal reshaping inlays, which reshape the anterior curvature of the cornea to enhance near and intermediate vision via a multifocal effect; and small-aperture inlays, which rely on pinhole optics to increase depth of focus by blocking unfocused light.

    Only a small percentage of presbyopes are emmetropic; therefore, an additional LASIK might be performed in the case of a compound refractive error. Femtosecond lasers provide more predictable flap thickness, lower incidence of dry eye, faster visual recovery and better uncorrected distance visual acuity (UDVA) than mechanical microkeratomes.2-4 When a laser flap is created, many nerve-fibre bundles are cut; however, a pocket interface minimises the impact on the corneal nerves.

    Corneal reshaping inlays

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