Simple Presbyopic Correction Technique

1. Al-Azhar University Egyptian Ophthalmological Society Simple Presbyopic Correction Technique Mahmoud M. Ismail, M.D Ph.D. Professor of Ophthalmology Al-Azhar University Medical Director Nour El Hayat Eye Center The Author has no financial interest in the material presented

2. Continuous change in techniques → unsatisfied results especially for Myopic Presbyopes …….?

3. Presbyopic Aspheric Ablations • Central Zone: Pupil-size dependent • Central steepening • Accounts for Intermediate and Near function • Peripheral zone • Distance Can this induce harmful HOAs ???

4. PresbyLasik,............. my experience • Target: oblate multifocal cornea (inducing -ve spherical aberration) to both eyes→ balance between far & near ………. BUT: • Halos and glare (Very Variable) • Distance vision better than near vision (or vice versa) • reduction of binocular vision • Intermediate region is always poor • Contrast Sensitivity ????? • So: patient’s satisfaction is compromised

5. Facts 1Patients Implanted with Intracorneal lenses are still not Presbyopes ? • Ismail MM.: Confocal study for intracorneal implants FDA phase 2-A. J Cataract Refract Surg. 2002 March ;28(3):527-30. • Ismail MM Correction of hyperopia by intracorneal lenses, two year follow-up. J Cataract Refract Surg 2006; 32:1657-1660.

6. Facts 2………….Stenopic effect ????? • Reviewer of Journal of Cataract and Refractive surgery: Acuofocus AC 7000: INTRACORNEAL IMPLANT • Stenopic Implant: → 2mm pin-hole effect • 5mm diameter AND : 10 microns THICKNESS Depth of focus

7. Fact 3:………………….Near Reflex • Esotropia • Lens Accomodation……& • Miosisand Centroid pupil shift

8. Technique: during myopic LASIK, dry peripheral zone in down –nasal quadrant Dry, Dry & Dry → it gets more flat Nasal side It gets more steep

9. Myopic Ablation Zone PresbyZone DownNasal

10. Rt Eye Presbyopic treatment

11. Presbyopia ..…….to be continued