What’s the best treatment for presbyopia? The short answer is, it depends. For some patients who come to see me, it is nothing. They just come too soon. Sometimes patients come to see me when they’ve just started to notice that their near vision isn’t quite what it was. But when I put them through the battery of tests I find that they still have quite a lot of accommodation, I advise them to leave it alone for the time being. I say, “look you’re okay for now. Come back and see me in a year or two.” You can tell roughly when it’s going to start getting to be more of an issue.

That’s a key thing. Their presbyopia has to have reached a point where it is causing a significant impact on function and quality of life.

Then the best treatment depends primarily on the condition of the patient’s crystalline lens inside their eye. I use a variety of tools to assess that carefully. A simple questionnaire tool, which determines the quality of vision combined with simple history-taking, clinical examination and then a suite of diagnostic tests using equipment that we’ve put together in the Custom Vision Clinic to assess the patient’s optical performance of their eye and condition of the lens inside the eye. Essentially, if they’re showing signs of significant cataract, then I will be steering that patient towards lens replacement surgery.

If the crystalline lens is clear and healthy but it’s just lost its flexibility, it has become rigid and caused presbyopia symptoms, then I’ll be exploring cornea based treatment, and that’s PRESBYOND blended vision LASIK laser eye surgery. It may not be an option because of the condition the tear film or because of the size of the prescription. But that will be the direction I’ll be heading.

So the short answer is it depends because both treatment options work extremely well, but they suit different patients eyes and different patients better. The key part of the care pathways is that initial assessment to work out which of the technology is going to suit that patient best and give them the very best outcome.