Patients with early presbyopia associated with high hyperopia form a unique category in that they pose challenges with regard to the options available for surgery. We highlight a few strategies for dealing with such patients where their refractive needs are balanced with financial considerations and long-term visual outcomes.
Surgical Options Summary: Refractive Lens Exchange (RLE)
For many patients with high hyperopia and early presbyopia, RLE is the preferred option. While offering the best quality of vision, it is offered to patients typically over the age of 55 years because of an increased risk of retinal detachment in younger patients.
Monofocal IOLs may be utilized in cases where the patient can’t afford the custom-manufactured multifocal IOLs; this is often along with mini-monovision techniques in order to correct both distance and near vision. Residual refractive errors following surgery may be further honed with the use of laser refractive techniques such as LASIK or PRK. In general, PRK will be preferred in some instances because it diminishes the complications of dry eye creation from surgery.
Custom IOLs and Additional Refractive Surgery
The ideal lenses for a glass-free population would thus be the multifocal or toric IOLs, but these, due to the limited powers available for IOLs, might require additional measures for correction. Options include secondary corneal refractive surgery or implanting a piggyback IOL for further refinement of vision. There is additional risk with the use of piggyback IOLs including pigmentary dispersion, and hyperopic corneal laser vision correction is generally discouraged for high degrees of hyperopia due to risks of regression and inaccuracy.
Cost Considerations Many patients cannot access these advanced types of multifocal IOLs due to financial reasons; therefore, the decision of surgical solutions is weighed against the long-term economic benefit of the glasses and contact lenses. Again, customized IOLs may be costly at first but offer an attractive lifestyle and cost-effective benefits over a period of time.
General Recommendations
In those who cannot afford the advanced IOLs, monofocal lenses in combination with other refractive modalities prove to be a fine option too. Precise selection of IOL power and astigmatism correction with corneal incisions or additional procedures would give good visual outcomes. However, the surgery of the lens remains the absolute indication of high hyperopia and early presbyopia, which in younger patients can be postponed to older ages or when they have become more suitable for RLE.
Final Thoughts
In patients with high hyperopia and early presbyopia, spectacle independence and contact lens can be tailor-made by an individualized surgical plan. Optimal results are often obtained with refractive lens exchange combined with some other corrective options depending on the patient’s financial and medical position. Meticulous planning, educating the patient, and personalized treatment ensure satisfaction with both long-term and visual outcomes.
At Texas Eye Care, we can guide you through the various options with an in depth consultation.
The doctors at the clinic are compassionate, and understand the importance of keeping you informed, and answering any questions you may have.
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