Presbyopia correction can be performed at the same time as cataract surgery. The goal is to restore comfortable distance vision, intermediate vision, and sometimes near vision, with very little need for glasses. Julien Gozlan, M.D. explains the treatment options, their benefits, and their limitations.
What is presbyopia correction?
With age, the crystalline lens loses its ability to accommodate: this is presbyopia. During cataract surgery, the opacified lens is removed and replaced with an intraocular implant. By selecting the appropriate implant and adopting a tailored strategy, it is possible to reduce dependence on glasses during the same surgical procedure.
Presbyopia correction during cataract surgery: the main options
1) Monovision
One eye is set for distance vision, the other for intermediate/near vision (moderate difference). Advantages: excellent image quality with no light-related side effects. Limitations: glasses are often still useful for fine print reading. This is a simple, effective, and very well-tolerated presbyopia correction approach for daily life, particularly in myopic patients.
2) Extended depth of focus implant (EDOF)
EDOF implants extend the range of clear vision. Result: comfortable distance and intermediate vision (computer, cooking, getting around), with glasses sometimes needed for very small print. Side effects (halos, nighttime glare) are generally limited. This is a balanced presbyopia correction option.
3) Multifocal implant (distance, intermediate, and near)
Multifocal implants redistribute light to cover multiple focal distances and aim for the most comprehensive correction. On the other hand, they can cause halos and nighttime glare as well as a slight reduction in contrast. Rigorous candidate selection greatly improves the chances of satisfaction.
4) A separate consideration: the benefit of toric implants
If astigmatism is present, a toric implant (available in monofocal, EDOF, or multifocal versions) corrects the corneal irregularity and improves the outcome. This is a key factor in optimizing presbyopia correction and achieving a sharper image.
How to choose your presbyopia correction?
The decision is personalized, following a thorough assessment: ocular biometry, corneal topography, tear quality, and macular evaluation by OCT. Your activities (reading, screen use, nighttime driving), your expectations, and your anticipated tolerance to side effects (halos, nighttime glare) guide the choice. The type of implant is then selected to achieve the best possible correction based on your profile.
Procedure and postoperative course
Cataract surgery is performed on an outpatient basis. The opacified lens is removed and the chosen implant is placed in the capsular bag. The correction is immediate, but vision stabilizes over a few days to a few weeks. Anti-inflammatory and antibiotic eye drops are prescribed, and normal activities can be resumed quickly by following the postoperative instructions.
Expected outcomes, limitations, and visual effects
Depending on the option chosen, you can achieve a high degree of independence from glasses (multifocal implant), be mostly self-sufficient for distance/intermediate vision (EDOF implant), or prioritize optical quality with monovision (monofocal implant). However, it is always a trade-off between spectacle independence and side effects. An open discussion about your priorities helps to manage your expectations as effectively as possible.
Frequently asked questions
- Is it possible if my macula is not perfect? A monofocal or EDOF implant is often preferred, for a gentler and higher-contrast presbyopia correction.
- Are the results long-lasting? Yes. The implant is permanent. A slight clouding of the capsule (known as posterior capsule opacification) may occur later and is treated with YAG laser.
FAQ: frequently asked questions about presbyopia correction during cataract surgery
How do I know if I am a good candidate for presbyopia correction?
The choice of presbyopia correction depends on several factors: the condition of the retina (particularly the macula), corneal regularity, tear quality, history of refractive surgery, as well as your activities (nighttime driving, screen work, extended reading). In practice, it is the comprehensive preoperative assessment and the consultation discussion that determine whether a high degree of spectacle independence can be targeted or whether a more cautious approach focused on visual quality is preferable.
Can monovision be "tested" before cataract surgery?
Yes, in some cases monovision can be simulated with contact lenses (one eye set more for distance, the other slightly more for near) for a few days or weeks. This helps verify whether your brain tolerates a slight difference in correction between the two eyes and anticipate the level of comfort that can be expected after cataract surgery with this type of strategy.
What happens if I am very sensitive to halos or glare?
Marked sensitivity to halos around lights or glare, especially at night, often leads to favoring gentler presbyopia correction solutions (monovision, monofocal implants, or certain extended depth of focus implants) rather than high-add multifocal implants. This point is discussed in detail during the consultation, as your nighttime driving habits and current level of discomfort strongly influence the choice of implants and visual target.
Is presbyopia correction compatible with AMD or other macular conditions?
In the case of macular disease (AMD, scarring, edema, epiretinal membrane, etc.), implants that maximize contrast are generally chosen, such as monofocal implants or certain EDOF lenses, and multifocal implants are avoided. The goal is then not to eliminate all glasses, but to achieve the most stable and comfortable vision possible given the retinal condition. The preoperative OCT assessment is therefore essential for tailoring the presbyopia correction strategy.
Are presbyopia-correcting implants covered by national health insurance and supplemental insurance?
The "standard" portion of cataract surgery is reimbursed by national health insurance, but EDOF, multifocal, or toric implants often involve an additional cost corresponding to a service classified as "non-listed." This portion may be more or less well covered depending on your supplemental health insurance plan. A detailed cost estimate is provided before the procedure so you can verify the exact level of reimbursement with your supplemental insurer.
Will I still be able to wear glasses after presbyopia correction?
Yes, and this is often an advantage: presbyopia correction with implants aims to significantly reduce dependence on glasses, but does not prevent occasional use. Some people prefer, for example, to keep a small pair of glasses for very fine print reading, detailed handiwork, or prolonged screen comfort, even though they can manage without them in the majority of everyday situations.
Can presbyopia correction be tailored to my screen work?
Yes, the distance at which you most frequently use your screens (computer, dual monitors, work instruments) is a key criterion in defining the visual target. For example, particularly comfortable vision between 60 and 80 cm can be prioritized with an extended depth of focus implant, or the correction of one eye can be slightly adjusted to optimize your usual working distance, even if this means keeping glasses for very close-up reading if needed.
Can the presbyopia correction strategy be changed several years after surgery?
In the vast majority of cases, the strategy decided at the time of surgery remains satisfactory over the long term. If your needs change (new professional activity, specific difficulty at a certain distance), it is almost always possible to adapt with glasses or, more rarely, consider a supplementary procedure on the cornea. Implant exchange is only indicated in very specific situations, after thorough discussion of the benefits and risks.
📍 Consultation at the Paris – Auteuil Ophthalmology Practice
Julien Gozlan, M.D. offers a personalized assessment for presbyopia correction during cataract surgery, selecting an implant and treatment plan tailored to your lifestyle.
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- Cataract: the condition underlying the surgery during which presbyopia can be corrected.
- Cataract implants: understanding the different families of implants and their specific features.
- Ocular biometry: the measurement used to select the implant power.
- Macular OCT: checking retinal health before any eye surgery.
- SFO fact sheet on premium implants: reference document on premium implants.