2020–2021 BCSC Basic and Clinical Science Course™
13 Refractive Surgery
Chapter 9: Accommodative and Nonaccommodative Treatment of Presbyopia
Nonaccommodative Treatment of Presbyopia
Corneal Intrastromal Femtosecond Laser Treatment
Femtosecond lasers may also be used to treat presbyopia. This minimally invasive approach is available in several countries outside the United States (but is not currently FDA approved) and does not involve incisions or flap creation. In this procedure, known as IntraCor, the femtosecond laser makes concentric rings within the stroma, starting in the center with a ring diameter of 1.8 mm, and proceeding with subsequent rings toward the periphery. The formation of these rings produces a localized biomechanical change that reshapes the cornea to create multifocality. The procedure is typically performed only in the nondominant eye. Studies have demonstrated that this procedure can benefit patients with hyperopic presbyopia (+0.50 D to +1.25 D), as the treatment causes an increase in the corneal true net power as well as a potential gain of 4–5 lines of near vision. It is important to counsel patients that uncorrected near vision is not significantly improved at 1 month postoperatively but that it is improved by 6 months in most cases.
Holzer MP, Knorz MC, Tomalla M, Neuhann TM, Auffarth GU. Intrastromal femtosecond laser presbyopia correction: 1-year results of a multicenter study. J Refract Surg. 2012;28(3): 182–188.
Menassa N, Fitting A, Auffarth GU, Holzer MP. Visual outcomes and corneal changes after intrastromal femtosecond laser correction of presbyopia. J Cataract Refract Surg. 2012; 38(5):765–773.
Ruiz LA, Cepeda LM, Fuentes VC. Intrastromal correction of presbyopia using a femtosecond laser system. J Refract Surg. 2009;25(10):847–854.
Thomas BC, Fitting A, Khoramnia R, Rabsiber TM, Auffarth GU, Holzer MP. Long-term outcomes of intrastromal femtosecond laser presbyopia correction: 3-year results. Br J Ophthalmol. 2016 Feb 22. doi:10.1136/bjophthalmol-2015-307672. Epub ahead of print.
Excerpted from BCSC 2020-2021 series: Section 13 - Refractive Surgery. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.