If smartphone text starts to look blurry around age 45 and holding the screen farther away makes it easier to read, presbyopia may be developing. You may wonder whether LASIK, SMILE, or SMILE pro could correct it.
Standard LASIK or SMILE performed to correct myopia and astigmatism does not also correct presbyopia. However, a presbyopia-specific treatment plan or a combined approach using PresbyMAX may help with near-vision difficulties. Laser correction for presbyopia does not restore the natural lens's ability to focus up close. Instead, it modifies the cornea to help support near vision.
It helps to understand what causes presbyopia, how its correction differs from vision correction in your 20s and 30s, and what treatment aims to achieve.
Why does presbyopia make nearby text blurry?
Light entering the eye passes through the cornea and natural lens before focusing on the retina. The lens changes shape to adjust focus for different distances. Looking at nearby objects requires more of this focusing ability, called accommodation.
As we age, the lens becomes harder and less flexible, making it harder to shift focus to nearby objects. This is presbyopia. You may find it easier to read a book or smartphone held farther away, or your eyes may tire more quickly when reading small print for a long time.
Presbyopia is more than a change in your glasses prescription. Myopia and astigmatism cause vision difficulties because incoming light does not focus correctly. Presbyopia is an age-related reduction in the ability to focus up close. It can therefore develop in people who already have myopia or astigmatism.
Hyperopia, or farsightedness, is a refractive condition in which the eye tends to focus light behind the retina. It can make near vision uncomfortable because more focusing effort is needed. Although both hyperopia and presbyopia can make nearby text difficult to see, their causes differ. An examination of your prescription, distance and near vision, and focusing ability helps distinguish them.
Presbyopia involves an age-related decline in accommodation. Standard corneal vision correction and presbyopia correction therefore differ in what they aim to correct and how they do so.
Can standard LASIK, SMILE, or SMILE pro also correct presbyopia?
Standard surgery that corrects myopia and astigmatism and targets distance vision in both eyes does not correct presbyopia. Helping with near vision requires a separate presbyopia-specific treatment plan. Having LASIK, SMILE, or SMILE pro does not automatically mean presbyopia correction is included.
LASIK creates a corneal flap and uses a laser to reshape the underlying stroma, changing the cornea's refractive power. SMILE and SMILE pro remove a small piece of corneal tissue called a lenticule through a small incision. Their procedures differ, but both approaches change corneal refractive power to correct myopia and astigmatism.
Correcting distance vision does not restore the natural lens's ability to accommodate. If you have presbyopia and both eyes are corrected for distance, you may rely less on distance glasses but still need reading glasses for nearby text.
Two questions should therefore be considered separately: whether someone with presbyopia is suitable for LASIK, and whether standard LASIK alone corrects presbyopia. The first concerns surgical suitability based on the cornea and overall eye condition. The second concerns the intended correction.
| Aspect | Standard correction of myopia and astigmatism | Laser correction that also considers presbyopia |
|---|---|---|
| Main goal | Correct refractive errors such as myopia and astigmatism | Address refractive errors and near-vision difficulties |
| Treatment planning | Prescription to be corrected and corneal condition | Existing prescription and corneal condition, together with the degree of presbyopia and a plan for both eyes |
| Relationship to lens accommodation | Does not restore the natural lens's accommodation | Uses corneal treatment to help compensate for reduced accommodation |
When SMILE is discussed together with presbyopia correction, it matters whether the plan involves SMILE alone or an additional presbyopia treatment. Even when the procedure names sound similar, the correction applied to each eye may differ.
How do laser approaches to presbyopia differ?
Presbyopia can be managed with glasses or contact lenses. Surgery may be considered if you want to reduce your reliance on glasses. Two approaches worth distinguishing are monovision, which sets different refractive targets for the two eyes, and PresbyMAX, which supports near and intermediate vision as part of a binocular treatment plan.
Monovision assigns different roles to the eyes: the dominant eye is corrected for distance and the non-dominant eye for near vision. The dominant eye is the eye you tend to rely on more; it is not necessarily the right eye.
The difference from PresbyMAX concerns how the focus of the two eyes is used. Monovision divides the roles between a distance-focused dominant eye and a near-focused non-dominant eye. PresbyMAX considers both near and intermediate vision to reduce the difference in focus between the eyes.
| Aspect | Monovision | EYEREUM's combined approach with PresbyMAX |
|---|---|---|
| Dominant eye | Corrected for distance | Corrected for distance with SMILE or LASIK |
| Non-dominant eye | Corrected for near vision | PresbyMAX supports near and intermediate vision |
| Characteristics of the visual range | Different target distances are set for the two eyes; intermediate vision and adaptation can vary by individual | A bi-aspheric profile in the non-dominant cornea supports near and intermediate vision while reducing the difference in focus between the two eyes. |
The comparison concerns the range of distances over which vision is clear. The actual range depends on each eye's condition and the treatment plan.
PresbyMAX for Presbyopia Correction
PresbyMAX is a laser treatment for presbyopia correction that helps support near and intermediate vision by creating a bi-aspheric corneal profile. It aims to broaden the range of clear vision and reduce dependence on reading glasses.
Standard myopia correction mainly targets distance vision. PresbyMAX, however, is designed to support a wider range of vision, including near and intermediate distances. It changes the cornea rather than removing the natural lens or placing a lens inside the eye.
Depending on the condition of the eyes, EYEREUM Eye Clinic uses SMILE or LASIK to correct the dominant eye for distance and PresbyMAX for the non-dominant eye. In the non-dominant eye, PresbyMAX creates a bi-aspheric profile to support near and intermediate vision while reducing the difference in focus between the two eyes.
This combined approach allows each eye to play a different role while working together. The treatment plan for each eye depends on the prescription, corneal condition, and degree of presbyopia.
In this way, SMILE or LASIK can support distance vision, while PresbyMAX helps extend the visual range toward intermediate and near vision. This differs from standard myopia or astigmatism correction, in which both eyes are generally targeted for distance vision.
How does having both myopia and presbyopia affect the plan?
Some people with myopia find nearby text easier to read without glasses. Without glasses, a myopic eye may naturally see more clearly at a closer distance, which can partly offset the reduced focusing ability caused by presbyopia.
Correcting both eyes for distance reduces this existing near-vision advantage. People with both myopia and presbyopia may therefore need reading glasses for nearby text after distance correction. Rather than assuming surgery suddenly caused presbyopia, it is more accurate to understand that the focusing conditions differ before and after myopia correction.
When myopia and presbyopia coexist, planning distinguishes between correcting the current myopia and astigmatism while using glasses for near vision, and combining that correction with presbyopia treatment. A combined plan determines the required prescription and amount of corneal correction for each eye.
For someone who already sees well at a distance and is bothered only by presbyopia, distance correction is not the primary goal. Planning instead focuses on how to help near vision while considering the distance vision already available. Two people of the same age, such as 45, may need different plans because their original refractive conditions and degree of presbyopia differ.
Your current glasses prescription and vision with and without glasses help explain these differences. Distance and near refraction tests and corneal examinations then help identify what needs correction and what should be maintained.
Who may be suitable for laser presbyopia correction?
Laser presbyopia correction may be considered if you want to reduce your everyday reliance on reading glasses or other glasses. Being in your 40s or 50s does not by itself determine the procedure. The cornea, natural lens, current prescription, and degree of presbyopia all need to be assessed together.
The first step is to check corneal thickness and shape and the prescription that needs correction to assess whether laser treatment is suitable. The examination also checks prescription stability and whether dry eye or the tear film is affecting measurements or vision.
The natural lens matters too. Presbyopia is a change in focusing ability, whereas a cataract is clouding of the lens. If cataracts are reducing vision, laser treatment for presbyopia alone may not address the problem. The evaluation must also consider whether treatment of the lens, such as cataract surgery, is needed.
The goal of presbyopia surgery is to reduce reliance on glasses. Glasses may still be needed for small print or precise tasks afterward. As with other laser vision correction procedures, some patients may experience visual symptoms such as dry eye, glare, or halos, so individual eye condition and expected benefits should be considered when planning treatment.
EYEREUM Eye Clinic considers myopia, astigmatism, the degree of presbyopia, and the condition of the cornea and natural lens when choosing a correction approach. The examination assesses both surgical suitability and the cause of the current vision difficulty, including whether corneal treatment may help.
