PresbyLASIK — freedom from glasses after 45
PresbyLASIK is a variant of LASIK adapted to presbyopia. Rather than simply correcting distance vision, I reshape your cornea according to a multifocal (or micro-monovision) profile that restores distance, intermediate and near vision at the same time. It is a relevant laser option for patients over 45 who want to reduce their dependence on both distance glasses and reading glasses, provided the natural lens is still clear.
Presbyopia is not inevitable
From the age of 45, the natural lens loses its ability to change shape to focus on near objects: this is presbyopia. The result is familiar to everyone: holding the newspaper further away, turning on more light, and eventually adopting reading glasses or progressive lenses. PresbyLASIK offers a laser alternative while the natural lens remains clear.
What is PresbyLASIK?
PresbyLASIK follows exactly the same technical steps as conventional LASIK: I create a corneal flap with a femtosecond laser (typical thickness 110–130 μm depending on the case), then reshape the cornea with an excimer laser, and finally reposition the flap without stitches. The difference lies in the reshaping profile I program.
Instead of producing a uniform surface dedicated to distance vision alone, the laser sculpts the cornea into a multifocal aspheric profile: the center of the cornea is dedicated to near vision and the periphery to distance vision (or the reverse, depending on the protocol). The brain learns to use, at every moment, the optical zone best suited to the distance being viewed. This is known as corneal multifocality.
Depending on your profile, I may also offer micro-monovision: I leave a slight residual myopia in the non-dominant eye (−1.00 to −1.50 D) to optimize near vision, while the dominant eye is corrected for distance vision. The brain then combines the two images. It is an alternative well tolerated by most patients, and gentler than conventional monovision.
Why a contact lens trial before surgery? Before any PresbyLASIK, I have you try, for a few days, contact lenses that simulate multifocality or micro-monovision. This trial lets you judge, in real-life conditions, how well you tolerate this type of vision — and tell me whether it suits you. It is a key step to better anticipate your adaptation and visual comfort after the procedure.
Animated demonstration below ↓
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PresbyLASIK step by step
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Interactive animation — for a larger view, open the diagram in full screen ↗
Multifocality or micro-monovision?
There is no single way to treat presbyopia with a laser. Depending on your profile — ocular dominance, type of refractive error, lifestyle, tolerance — I guide you toward the most suitable strategy.
- Both eyes receive a multifocal aspheric profile
- Each eye sees both far and near at the same time
- Particularly suitable for patients with hyperopia and presbyopia
- Full binocular vision preserved
- Requires a neuroadaptation period (3 to 6 months)
- Overall result: low dependence on glasses at all distances
- The dominant eye is corrected for distance vision
- The non-dominant eye is made slightly myopic (−1.00 to −1.50 D) for near vision
- A gentle solution, very well tolerated by most patients
- Quick adaptation (a few days to 2 weeks)
- Contact lens trial required before the procedure
- Excellent balance between distance and near vision
The two approaches can also be combined: mild multifocality in both eyes with a slight refractive offset between the eyes. The choice is always tailored to you, following the comprehensive assessment and the contact lens trial.
Who is PresbyLASIK for?
PresbyLASIK is a worthwhile solution in many situations, but not for every patient. The comprehensive assessment allows me to confirm your eligibility — and above all to check that this technique matches your expectations and your lifestyle.
- You are between 45 and 60 years old
- Your presbyopia is established and bothersome in daily life
- Your natural lens is still clear (no early cataract)
- You have hyperopia with presbyopia (ideal profile) or moderate myopia with presbyopia
- Your cornea is thick enough
- Your prescription is stable
- You tolerated the multifocal / monovision contact lens trial well
- You want to be free of glasses for distance and near vision
- You have an early cataract → lens surgery with an EDOF / multifocal intraocular lens is more appropriate
- Your cornea is too thin or irregular (keratoconus, suspected keratoconus)
- You have severe, uncontrolled dry eye disease
- You have extreme visual demands (fighter pilot, microsurgeon…)
- You tolerate the multifocal contact lens trial poorly
- You have high irregular astigmatism
- You have a retinal disease (AMD, diabetic maculopathy)
If PresbyLASIK is not the ideal option, lens surgery with an EDOF or multifocal intraocular lens remains an excellent alternative — we will discuss this together.
Advantages and points to consider
- A high degree of independence from glasses for distance and near vision in daily life
- A quick, painless outpatient procedure — just like conventional LASIK
- Distance vision recovers from the next day
- Your natural lens is fully preserved
- A laser enhancement is possible after a few months if needed
- A strategy tailored to your ocular dominance and your lifestyle
- A neuroadaptation period of 3 to 6 months is normal — vision stabilizes gradually
- Halos and glare at night are possible, usually temporary
- Slight compromise on distance vision compared with conventional monofocal LASIK
- The natural lens continues to age: in the long term (10–15 years), a cataract may develop and require further surgery
- An enhancement may be offered in 5 to 10% of cases to fine-tune the result
- PresbyLASIK is poorly suited to extreme visual demands (strict night-vision requirements, high-performance piloting)
From your first assessment to visual freedom
Comprehensive pre-operative assessment
At your first consultation, I carry out a comprehensive assessment tailored to presbyopia: measurement of your distance and near prescription, corneal mapping (Anterion), pachymetry, aberrometry, measurement of ocular dominance, and examination of the natural lens and the back of the eye (fundus). I make sure there is no early cataract, which would change the strategy.
Contact lens trial
A key step of PresbyLASIK: for a few days, you try contact lenses that simulate the result (multifocality or micro-monovision). You test them in real-life conditions: driving, screens, reading, sports. If the experience works for you, we move on to surgical planning. If not, we explore other options.
The day of surgery
The procedure takes about 15 minutes for both eyes, as an outpatient, under anesthetic eye drops. The procedure is technically identical to LASIK: femtosecond flap, multifocal excimer reshaping, repositioning of the flap. You go home 30 minutes later, ideally with someone accompanying you.
Follow-up & neuroadaptation
I see you again at Day 1, Day 7, Month 1 and Month 3. Distance vision is clear from Day 1. Near vision improves over the following weeks: this is neuroadaptation, during which your brain learns to interpret the new corneal geometry. Be patient — optimal visual comfort is generally reached between Month 3 and Month 6.
What happens after PresbyLASIK?
Recovery is quick for distance vision and more gradual for near vision. Here are the usual milestones — every patient recovers at their own pace.
The day of surgery
Stinging, a foreign-body sensation and light sensitivity are normal. Rest your eyes: no screens, no reading. First application of the prescribed eye drops.
First check-up
Distance vision is already clear, sometimes excellent. Near vision is usable but not yet optimal. You may resume short drives. Sunglasses are mandatory outdoors.
Back to work & light exercise
Full return to screen work. Walking, cycling, running. Night-time halos and the "double image" sensation when reading fade day by day. This is the neuroadaptation phase.
Stabilization check-up
Distance vision is stable. Near vision is still improving. You may return to swimming, contact sports and diving.
Functional result
Binocular vision is stable at all distances. Most patients become largely independent of glasses for everyday activities (occasional reading, smartphone, screens, driving). A small pair of "backup" glasses may remain useful for very fine tasks (extended reading in dim light).
Final assessment
Neuroadaptation is complete. If an enhancement is needed to fine-tune the result (5 to 10% of cases), this is the stage at which it is scheduled.
PresbyLASIK or lens surgery?
Between 45 and 55 with a clear natural lens, PresbyLASIK is often the ideal option. Beyond 55–60, or if an early cataract is present, lens surgery with an EDOF/multifocal intraocular lens becomes more appropriate. Here is a brief comparison.
| PresbyLASIK | EDOF / Multifocal IOL | Monofocal LASIK + glasses | |
|---|---|---|---|
| Ideal age | 45–60 years | 55 years and over | All ages |
| Procedure | Cornea (laser) | Replacement of the natural lens | Cornea (laser) |
| Distance vision | Very good (slight compromise vs monofocal) | Excellent | Excellent |
| Near vision | Good, sometimes excellent depending on adaptation | Excellent | Glasses required |
| Effect on future cataract | None (surgery needed later) | Permanent (cataract treated) | None |
| Recovery | 24 h for distance vision · 3–6 months neuroadaptation | 1–2 days · 1 month neuroadaptation | 24 h |
| Reversibility | Enhancement possible | IOL exchange possible | Enhancement possible |
PresbyLASIK fees
PresbyLASIK: €3,200 for both eyes — this all-inclusive fee covers the procedure, post-operative check-ups and any enhancement needed within the year. For your information: these are unregulated fees, not reimbursed by the French national health insurance (Assurance Maladie); some complementary health insurance plans (mutuelles) contribute, depending on your policy. A detailed quote is always provided before any decision, and payment in installments may be offered — ask about it during your consultation.
PresbyLASIK FAQ
Your PresbyLASIK assessment starts here
A comprehensive assessment allows me to check your eligibility, test together how well you tolerate multifocality or micro-monovision, and choose with you the strategy best suited to your life.
Explore the alternatives
If PresbyLASIK is not the ideal solution for you, other options exist — suited to your age, your cornea and the clarity of your natural lens.