Laser eye surgery has corrected myopia, hyperopia and astigmatism for decades. However, conventional distance correction does not address presbyopia, the age-related loss of near focusing ability that eventually affects almost everyone.
PRESBYOND® Laser Blended Vision was developed specifically to manage this change. Rather than replacing the natural lenses inside the eyes, it uses a personalised corneal laser treatment to create a greater range of functional focus across both eyes.
What Is Presbyopia?
Presbyopia is the gradual loss of the eye’s ability to focus on close objects. The word comes from Greek and is commonly translated as “ageing eye”.
When we are younger, the natural crystalline lens inside the eye is flexible. It changes shape to adjust focus as we look between distant and nearby objects. This process is known as accommodation.
As the lens ages, it becomes firmer and less responsive. The eye can no longer increase its focusing power as easily, making close text and detailed near tasks progressively more difficult.
Most people begin noticing the effects during their forties, although the exact age and rate of progression vary.
Common Signs of Presbyopia
- Holding a phone, menu or book further away
- Needing brighter light to read comfortably
- Difficulty focusing on small print
- Eyestrain or headaches after close work
- Taking longer to refocus between near and distance
- Removing distance glasses to read, particularly if short-sighted
Holding text further away may help temporarily because it reduces the focusing demand placed on the eye. Eventually, however, reading glasses, bifocals, varifocals or another form of correction usually becomes necessary.
Can Laser Eye Surgery Correct Presbyopia?
Laser treatment cannot make the ageing natural lens flexible again. It can, however, alter the optical system of each eye to help compensate for the loss of accommodation.
PRESBYOND® Laser Blended Vision is a LASIK-based treatment that creates a carefully controlled difference between the two eyes:
- The dominant eye is primarily corrected for distance vision while retaining some intermediate focus.
- The non-dominant eye is primarily corrected for near vision while retaining some intermediate and distance focus.
Each eye is also given an individually calculated increase in depth of focus. This creates an overlapping range of useful vision known as the Blend Zone.
The brain combines the visual information from both eyes, allowing the patient to use near, intermediate and distance vision together. This is why PRESBYOND is different from conventional monovision, where one eye is simply focused at distance and the other at near with less overlap between them.
Vision Across the Distances That Matter
Near Vision
Reading messages, menus, labels and printed text.
Intermediate Vision
Computer screens, dashboards, cooking and conversation.
Distance Vision
Driving, television, signs, sport and outdoor activities.
The aim is not to make the eyes perform three separate visual tasks. It is to create a continuous binocular range of focus that feels natural during everyday life.
How Is PRESBYOND Personalised?
PRESBYOND is not a standard treatment profile. Planning considers the patient’s prescription, age, pupil size, visual dominance, pre-existing optical aberrations and tolerance of the intended difference between the eyes.
Wavefront data are used to optimise the treatment profile for each eye. The degree of near correction and extended depth of focus can then be adjusted around the individual patient rather than applying the same target to everyone.
Your assessment may include a simulation using trial lenses or contact lenses. This helps the clinical team understand how comfortably your visual system adapts before permanent correction is considered.
PRESBYOND is not simply “one eye for near and one for distance”. Its defining feature is the overlapping Blend Zone that helps preserve useful binocular vision between those focal points.
Pioneered at London Vision Clinic
London Vision Clinic founder Professor Dan Reinstein played a central role in developing Laser Blended Vision and the clinical protocols behind the treatment.
London Vision Clinic became the first UK laser eye surgery clinic to offer PRESBYOND in 2009. The treatment was subsequently incorporated into the ZEISS refractive laser platform and is now used by trained surgeons internationally.
The clinic’s long-term experience is particularly important because treating presbyopia requires more than performing a standard distance correction. The surgeon must understand how the two eyes interact, how the patient uses their vision and how their requirements may change with age.
What Results Can Patients Expect?
The aim of PRESBYOND is to reduce dependence on reading glasses while maintaining useful distance and intermediate vision. Outcomes vary according to the starting prescription, age, eye health and individual response to the treatment.
Clinical results published by London Vision Clinic report that:
could read normal newsprint-sized text after treatment.
could read small print comparable to medicine inserts.
These figures do not guarantee that every patient will be completely free from glasses. Some people may still prefer additional correction for very small print, prolonged reading, dim lighting or visually demanding tasks.
When reviewing outcomes, it is important to compare patients with prescriptions and visual requirements similar to your own. The clinic provides further information on its results and statistics page.
Who May Be Suitable for PRESBYOND?
PRESBYOND may be considered for patients who:
- Are experiencing age-related difficulty with near vision
- Want to reduce their reliance on readers, bifocals or varifocals
- Have a stable prescription
- Have healthy corneas and a suitable ocular surface
- Do not have a visually significant cataract
- Can comfortably adapt to the planned blended correction
- Have realistic expectations about near, intermediate and distance vision
PRESBYOND can be considered for people who previously had good unaided distance vision as well as those with myopia, hyperopia or astigmatism.
Suitability cannot be established by age or prescription alone. A comprehensive assessment is required to examine the corneas, natural lenses, eye health and the way both eyes work together.
When Might Another Treatment Be Recommended?
If the natural lens has developed a cataract or significant age-related changes, corneal laser treatment may not be the most appropriate long-term option. In these circumstances, cataract surgery or lens replacement surgery may be considered.
Other patients may be better served by reading glasses, varifocals, multifocal contact lenses or continued monitoring. The recommendation should reflect the health of the eye and the patient’s visual priorities rather than a desire to perform surgery at any cost.
Does PRESBYOND Stop Presbyopia?
No treatment can stop the natural crystalline lens from continuing to age. PRESBYOND manages the visual effects of presbyopia by changing the focusing profile of the cornea, but it does not reverse the underlying loss of lens flexibility.
The corneal correction is designed to be long-lasting. However, the natural lens and other structures inside the eye can continue to change. Some patients may therefore benefit from an adjustment or additional correction later in life.
What Is Treatment Day Like?
PRESBYOND is performed using a LASIK-based technique. Anaesthetic eye drops are used to numb the surface, and the surgeon talks the patient through each stage.
A thin corneal flap is created and lifted before an excimer laser applies the personalised correction. The flap is then returned to its original position, where it begins healing naturally.
Most patients describe pressure, brightness or unusual sensations rather than pain during the procedure. Vision may initially appear misty or watery and will continue to settle during recovery.
In this video, London Vision Clinic patient Ken recalls his experience on the day of his PRESBYOND® Laser Blended Vision procedure.
Five Questions to Ask Your PRESBYOND Surgeon
Presbyopia correction requires careful treatment planning and experience with binocular vision. Before proceeding, ask your surgeon:
How many PRESBYOND procedures have you performed?
Experience with standard distance LASIK does not automatically equal experience in personalised presbyopia correction.
How will you test whether I can adapt to blended vision?
Your tolerance of the intended focus difference should be assessed as part of treatment planning.
What outcomes do you achieve for patients like me?
Results should be considered in relation to your age, prescription and visual requirements.
When might I still need glasses?
A responsible consultation should explain likely limitations as clearly as the potential benefits.
What happens as my eyes continue to age?
Ask about long-term monitoring, possible adjustment and how future cataract surgery would be planned.
Your surgeon should also have access to detailed diagnostic measurements, modern vision correction technology and outcomes for comparable patients.
What Do PRESBYOND Patients Say?
“This was not simple monovision. In a couple of months, I had surgery at London Vision Clinic. More than six months after surgery, my vision was great and I could read a newspaper at 15cm. I am very glad I did it.”
Dr Pait Teesalu, Ophthalmic Surgeon
“Only six hours after the procedure, I glanced across the work surface and realised I could read the newsprint without my glasses. No more searching for lost glasses when shopping and no more embarrassing moments in restaurants.”
Adele N, Fitness Trainer
“Thank you to the staff and Dr Carp for a very thorough pre-surgery consultation, which put my fears at rest. Dr Carp talked me through each step methodically. One day later, I had very little discomfort and good vision.”
Grainne M, Lawyer
Further experiences from laser and lens patients can be found on the clinic’s patient reviews page.
Could PRESBYOND Help You Leave Reading Glasses Behind?
If you rely on reading glasses, bifocals or varifocals, PRESBYOND may provide a laser-based alternative. However, the treatment must be planned around your individual eyes, tolerance and long-term visual needs.
The first step is a detailed consultation to determine whether your corneas, natural lenses and binocular vision are suitable for treatment.
To discuss your reading vision, contact one of our Patient Care Coordinators. Alternatively, book a consultation at London Vision Clinic.