1. Simple Presbyopic Correction Technique Mahmoud M. Ismail, M.D Ph.D. Professor of Ophthalmology Al-Azhar University Medical Director Nour El Hayat Eye Center The Author has no financial interest in the material presented Egyptian Ophthalmological Society

2. Presby LASIK ? Continuous change in techniques → unsatisfied results especially for Myopic Presbyopes ……. ?

3. Presbyopic Aspheric Ablations Central Zone: Pupil-size dependent Central steepening Accounts for Intermediate and Near function Peripheral zone Distance Can this induce harmful HOAs ???

4. PresbyLasik,............. my experience Target: oblate multifocal cornea (inducing -ve spherical aberration) to both eyes → balance between far & near ………. BUT:  Halos and glare (Very Variable)  Distance vision better than near vision (or vice versa)  reduction of binocular vision  Intermediate region is always poor  Contrast Sensitivity ?????  So: patient’s satisfaction is compromised

5. Facts 1 Patients Implanted with Intracorneal lenses are still not Presbyopes ? Ismail MM.: Confocal study for intracorneal implants FDA phase 2-A. J Cataract Refract Surg. 2002 March ;28(3):527-30. Ismail MM Correction of hyperopia by intracorneal lenses, two year follow-up. J Cataract Refract Surg 2006; 32:1657-1660.

6. Facts 2………….Stenopic effect ????? Reviewer of Journal of Cataract and Refractive surgery: Acuofocus AC 7000: INTRACORNEAL IMPLANT Stenopic Implant: → 2mm pin-hole effect 5mm diameter AND : 10 microns THICKNESS Depth of focus

7. Fact 3 :………………….Near Reflex Esotropia Lens Accomodation……& Miosis and Centroid pupil shift

8. Technique: during myopic LASIK, dry peripheral zone in down –nasal quadrant Nasal side Dry, Dry & Dry → it gets more flat It gets more steep

9. PresbyZone Down Nasal Myopic Ablatio n Zone

10. Rt Eye Presbyopic treatment

11. Presbyopia..…….to be continued