Thanks to the new generation of lenses, more than 90% of our patients do not require any more their glasses for reading or long-distance vision.
Presbyopia is not a disease, but an age-related process. With increasing age the natural lens becomes increasingly inflexible and the eye loses the ability to focus close objects. Monovision or implantation of multifocal lenses are two established methods of treating presbyopia, finally being able to live a life without glasses. Our surgeon Dr. Breyer is one of the few specialists of micro-incision surgery worldwide who routinely perform implantation of a lens through an incision of only 1.5 - 1.6 mm. He was the first to implant a lens in severe cases of high astigmatism; these implantations as well as his international lectures and Live Surgeries made him well known and accepted scientifically all over the world. The advantages of this micro-incision technique include the significantly shorter periods of healing, fewer side effects of surgery and no induction of astigmatism. Therefore it is a perfect surgical tool for refractive surgery in complicated cases and high patients needs.
How does presbyopia occur, and what are the symptoms?
During accommodation, the flexible lens dynamically changes its refraction power in the eye. If the flexibility of the lens decreases with advanced age, then also the ability to change the refraction power will decrease; this is a process that starts very early in age, but it only shows first symptoms starting at the age of approx. 40 years. This particularly affects the vision of close objects, and thus also reading - first only small-printed letters, and later on also normal text. Glasses enable clear vision of close objects; however, for long-distance vision the glasses should be removed, and they also require regular adjustment to the progress of presbyopia.
Monovision enables many people to live without glasses.
Monovision or Goethe vision as a treatment method.
In monovision, one eye - the so-called leading eye - is set to good long-distance vision, and the other eye is set to good short-distance vision. This intervention enables many people to live without glasses. However, stereoscopic vision could be slightly limited. Thus, e.g. watchmakers require additional glasses to set the long-distance eye to short distance. As approx. every 5th person is not able to manage this solution in daily life, monovision is simulated before actual treatment using different contact lenses. If such contact lenses are used without problems, then usually monovision treatment will also be promising. If intolerance only occurs later, then both eyes can be reset to the identical distance by means of a second intervention.
Implantation of multifocal lenses enables long-distance and short-distance vision without the varifocal effect.
Surgical replacement of the own inflexible lenses by a multifocal lens is a modern method for treatment of presbyopia. Multifocal lenses combine two or more focal distances by concentric stages and simultaneously enable long-distance and short-distance vision. Adjustment period usually amounts to one to three months; after such period, most patients can see long-distance and short-distance objects - without glasses and without the varifocal effect. The new lens generation also reduces halo and dazzling effects and provides of a significantly higher tolerability.
Today, artificial lenses are implanted by gentle micro-incision methods.
Implantation of lenses is deemed to be technically mature and safe - given the approx. 800,000 operations per year in Germany alone. Particularly in very complicated cases with astigmatism, Dr. Breyer is one of the internationally renowned experts. Within the scope of a prospective, international and multi-centre study (L-TVG) he operated on the first patients and presented the results on various meetings. For more information on cataract surgery, please read the chapter on cataract.
Who does not qualify for multifocal lenses?
Unfortunately, multifocal lenses are not suitable for everyone. As some patients experience the stated dazzling and halo effects and lower contrasts - as compared to the natural lens - after implantation of multifocal lenses, this method is not perfect e.g. with professional drivers who often drive at night. It is also not the best choice for persons who suffer from a macular disease, sicca or other indications, e.g. keratoconus. Multifocal lenses are also only of limited use for people as of 80 years.
For further information on intraocular lenses, Calhoun light-adjustable lenses and add-on lenses, please read the chapter premium lenses. We would be pleased to advice you on the type of lens that is most suitable for you.