PRESBYOND – LASER BLENDED VISION (LBV)

What is PRESBYOND?

As we get older, the lens inside the eye loses its ability to accommodate, that is, the ability to change shape which allows us to see clearly at all distances. As a result, there is a need to wear glasses for near, and later for distance vision as well.
PRESBYOND is the laser surgery that allows you to become spectacle independent when you have presbyopia and consists of changing the shape of the cornea so that you can see without glasses both at a distance and at close range in most situations.
The dominant eye is corrected to see at distance and intermediate, and the non-dominant eye is corrected to see at middle and close range, by using the Extended Depth of Focus technique. The brain succeeds in compiling the images obtained from
each eye and giving you a good image. The only clinic in Romania where you can benefit from this surgery is Ama Optimex Eye Clinic, in Bucharest. The only accredited doctors in Romania to do this technique are Dr. Andrei Filip, Dr. Miruna Nicolae
and Assoc. Prof. Mircea Filip.

What does PRESBYOND do in particular?

PRESBYOND is a new approach to refractive surgery that allows us to perform a personalized treatment and gain independence from glasses in most situations by a safe laser technique. Benefits of PRESBYOND:

• the treatment is customized for each patient, following multiple pre-surgical investigations and tests;
• independence from glasses in most situations, the vision is good at all distances;
• the surgical technique is the least invasive of all surgical options for presbyopia, following the same protocol as the FemtoLASIK technique, a safe procedure performed over 30 years, all over the world;
• results are immediate, vision is good after surgery and improves as the days go by.

Who is a good candidate for PRESBYOND?

People who have reached the age of presbyopia, meaning 40 years old, who must wear glasses both at distance and near (myopia, hypermetropia, astigmatism) and want to get rid of the glasses. Only the doctor can tell you whether or not you are a suitable
candidate for this intervention after a specific consultation and set of investigations.

It is important to understand that presbyopia affects all people at some point in their lives. There is a variety of corrective options, ranging from glasses, contact lenses, to laser surgery and replacing the lens with a multifocal artificial one.To
find out what options are suited in your case and which is best for you and your lifestyle, we look forward to a consultation.

What Investigations Are Required Before surgery?

To determine if you are a suitable candidate for PRESBYOND, you should perform a set of specific ophthalmologic investigations, targeted on several anatomical features of your eyes:

• automated refraction and keratometry;
• visual acuity with the best optical correction for distance and near;
• pupillary and corneal diameters;
• Corneal topography;
• Pentacam corneal tomography;
• Corneal pachymetry;
• Biometry with IOL Master 500;
• Posterior segment examination visual field exam;
• intraocular pressure;
• cycloplegia using drops. Attention!! Driving is not recommended after dilating drops have been administered.

Following these investigations and by correlating the results, your doctor will advise you on the best solution for you.

Who is not a candidate for this surgery?

You are not a good candidate for Presbyond if you:

• have keratoconus, irregular astigmatism, suspected glaucoma or high intraocular pressure;
• have any residual, recurrent or active eye disease;
• you have previously had corneal surgery of any kind of surgery performed on the eye to be treated;
• Dry eye syndrome that cannot be treated or does not responds to treatment;
• have an autoimmune condition, connective tissue disease or diabetes, a history of herpes simplex or herpes zoster keratitis
• you sustain chronic treatment with systemic medication that affects wound closure and healing, such as corticosteroids or antimetabolic agents;
• you are pregnant or breast-feeding.

Advantages of femtosecond laser use

• The flap, with a thickness and shape determined individually, is cut with maximum accuracy by the femtosecond laser, meaning that a few microns accuracy is achieved without touching the cornea outside the target area;
• Extreme precision of the computer-controlled laser incision allows for high-precision surgery;
• postoperative pain is often very low;
• no scars appear on the corneas visible to the naked eye, but the edge of the flap may be visible under biomicroscope;
• short recovery time.

How will I feel after surgery?

The first follow-up is done immediately after the intervention. After about 30 minutes of resting with the eyes closed, the doctor will check the flap position before you are free to leave the clinic. Then you can go home, preferably accompanied by someone
of your choosing, because you will not be able to drive. You also need to wear sunglasses when going outside. Normally, this procedure does not hurt, but on the first day you might experience mild burning, sometimes even stinging, photophobia,
more abundant tearing than normal. In principle, your vision stabilizes immediately after surgery and improves during the following day, but you may have fluctuations of your vision during the first period.

What should I do after surgery?

For a month:

• The most important thing is to follow the doctor’s instructions and let the clinic staff know if you think the recovery is not normal;
• follow strictly the treatment prescribed by your doctor
  do the follow-ups your physician has recommended;
• wear quality sunglasses when leaving the house;
• wear protective goggles during sleep to avoid rubbing your eyes involuntarily;
• follow the hygiene rules (wash / disinfect your hands before you apply your treatment or put your hands near the eyes) – In case of laser treatments, the infections are rare, depending on hygiene and treatment compliance;
• wipe your eyes with sterile napkins;
• avoid eye contact with water (you should wash your head like at the hairdresser) or other substances, different from the drops prescribed by your doctor;
• if visual comfort allows, you can watch TV, work on your computer and read right after surgery.

What should I not do after surgery?

The first month after surgery, the following are prohibited:

• rubbing your eyes;
• high physical effort, intense sports activities;
• eye contact with water or other substances that can cause irritation or infection;
• facial cosmetic treatments, makeup, cream around the eyes, hair dyeing;
• going to the pool, sauna, solarium, sea, beach;
• areas with abundant dust.

How long does postoperative treatment last?

The treatment lasts for about 3 weeks, depending on the evolution and physician’s recommendation, this period may be subject to change.

How will I see after surgery?

Immediately after surgery, vision is good and continues to improve every day. However, in the early days, there is a mild discomfort and variations in visual acuity. In the first few weeks, even months, vision fluctuations may occur, but you can go to
work, and you can resume most of your current activities. The period of neuroadaptation lasts for about 4-6 months, during which the brain will be able to compose the images obtained from each eye, and the sight will become good both at distance
and for reading. It is very important to understand that postoperatively the vision will be different when perceived with each eye separately, so the dominant eye will see well at distance and intermediate, and the nondominant eye will see well
at near and intermediate. Sometimes it may be necessary to temporarily wear glasses during the healing period until the refractive stabilization is achieved. There are situations where some people may need to wear glasses even after a period of
neuro-adaptation, in particular situations, when they are tired, when reading very small characters or in low light, when driving (for example on long distances, in low light and contrast conditions, at night, etc.).

What complications can occur?

Complications associated with this procedure are very rare, using the femtosecond laser to create the flap further reducing the associated risks. Currently, we can say that PRESBYOND surgery is a very safe procedure for becoming spectacle independent.
Thus, the complications that may occur are:

• dry eye syndrome;
• decreased night vision (halos) may occur especially in the first months after surgery; it rarely remains permanent;
• sensitivity to light appears quite rare, however, some patients experience photophobia, which is transient, rarely remains permanent;
• corneal ectasia;
• corneal folds;
• retinal damage;
• epithelial invasion under the flap;
• incomplete flap creation and / or inability to perform the operation;
• infections;
• loss of corneal transparency;
• the need for corneal transplantation;
• loss of vision;
• accommodative spasm;
• regression of diopters;
• increased intraocular pressure following treatment with substances used intra and / or postoperatively;
• the patient’s inability to overlap the images received from each eye and to adapt to the new situation, in which case it is necessary to wear glasses.

ATTENTION, in the event of complications, it is important to notify the clinic staff as a matter of urgency and your cooperation in administering the treatment and in following the doctor’s recommendations is extremely important!!

Can I lose my eyesight?

The risk of losing eyesight is real after any surgery! As long as the ophthalmologist is experienced, works with high-end technology and you follow all the recommendations received, the laser surgery has a very high degree of safety, over 99%, and the
risk of vision loss is extremely low, below 1: 1000000. Laser diopter correction has a very high success rate, is easily tolerated by the patient and the healing is fast.

When do I have to come for follow-up?

Compulsory follow-ups are done in the first 24 hours and after 7 days postoperatively, then at 1 month or 3 months, 6 or 12 months, depending on the need or the doctor’s recommendation. Total recovery may take up to a few months, depending on each person,
and postoperative recovery is favorable in most cases.

How stable are the diopters after PRESBYOND?

The body is in a permanent and continuous change, and this type of surgery seeks to compensate for the unpleasant visual effects induced by age-related changes of the lens. From this we understand that as long as the lens modifications are ongoing until
cataract appears, the diopters can change over time. At this stage of life, from the corneal point of view, the diopter regression occurs rarely, but the incidence of regression increases as the corrected diopters are higher. If refractive changes
occur, the doctor will determine if another surgery is necessary or if a new procedure can be performed, called enhancement

Cataract surgery after PRESBYOND?

Over 70% of healthy people will develop cataract after 65-70 years or later. However, there are rare situations in which this condition may also occur at younger ages. Currently, the only method of treating cataract is surgery, where the surgeon replaces
the opaque lens with an artificial one. If cataract occurs in a person who has already had PRESBYOND surgery, the doctor will determine after a consultation and a set of investigations what kind of artificial lens will be appropriate for that
person, including the possibility to keep the benefits provided by PRESBYOND after having cataract surgery.