Updated on 

May 3, 2022

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Presbyopia Surgery: Types and Costs

What is Presbyopia?

Presbyopia is an age-related eye condition where the eyes lose the ability to focus on objects. It’s also commonly referred to as age-related farsightedness. This condition is common in the early to mid-40s and worsens over time. 

Your surgeon can confirm presbyopia during a routine eye exam. Treatment options are based on the extent of your refractive error

Research estimates that about 1.782 billion people will have presbyopia by 2050. Early presbyopia can be corrected with eyeglasses or contact lenses. In some cases, your surgeon may recommend surgery.1

Causes

Your natural eye lens is flexible. This allows the eye’s shape to change when focusing on distant or near objects, which enables clear vision. As you age, your eye lens may start to harden, and nearby objects start to appear out of focus.2

If you notice that you can’t read a book or newspaper unless you hold it at arm’s length, you may have presbyopia.

Symptoms 

Common symptoms of presbyopia include:

  • Inability to focus clearly on nearby objects
  • Squinting 
  • Eyestrain or headache after close-up activities such as reading a book
  • Eye fatigue after doing close-up work
  • Poor night vision

Risks

Presbyopia is common in older adults. However, some diseases and drugs can also cause presbyopia in younger people (premature presbyopia).3

Premature presbyopia may signal an underlying condition such as:

  • Anemia (insufficient or low-quality red blood cells in the blood)
  • Heart diseases such as atherosclerosis, congenital heart defects, or other heart infections
  • Diabetes
  • Multiple sclerosis (a chronic illness affecting the brain and spine)
  • Eye disease or trauma
  • Poor blood flow

Common drugs associated with premature presbyopia include antidepressants, antihistamines, and diuretics.

6 Presbyopia Surgery Options

Initially, the only treatments for presbyopia were glasses and contact lenses. Today, surgical options are approved inside and outside the U.S., and new ones are still in development. 

The following are some effective surgical options for correcting presbyopia:

1. Monovision LASIK

The standard LASIK procedure involves reshaping the cornea to improve vision. Monovision LASIK or blended vision surgery is a special technique where the dominant eye is corrected for distance vision and the non-dominant eye for better near vision. This enables clear vision at any distance.

Although both eyes are set to see differently, most people adapt well. However, others may take time to adjust. To avoid this, surgeons often recommend trying monovision contact lenses before committing to surgery.4

It’s also possible to lose some depth perception (ability to judge the size or distance of objects in your visual field).5

Monovision LASIK is ideal for people who want to stop wearing eyeglasses, although they might still need them when reading small print.

Ideal Candidate

You may qualify for monovision LASIK if you’re:

  • Diagnosed with presbyopia
  • In good general health
  • Free from eye diseases
  • Have thick corneas
  • Have a stable vision prescription for about one to two years
  • Have no eye conditions that can affect surgery or healing
Procedure

The monovision LASIK procedure is similar to standard LASIK. It’s a quick outpatient procedure done under topical anesthesia.6 Your surgeon may also administer sedatives to help you relax.

Next, your surgeon will use a sharp blade known as a microkeratome to create a flap on the corneal surface, exposing the tissue. They will then use a device known as an excimer laser which uses mild UV rays to reshape the cornea. One of your eyes will be set for distance vision and the other for near vision.

A more advanced technique is the bladeless LASIK (iLASIK), which eliminates the use of the microkeratome and instead uses laser technology to create the flap. It’s also computer-guided, meaning fewer complications.

After reshaping the cornea, the surgeon will reposition the flap. No stitches are needed. 

The procedure takes about 10 to 15 minutes per eye. After surgery, your surgeon will prescribe pain relievers, antibiotic eye drops, and lubricating eye drops to ease any discomfort.

Most people adapt to monovision surgery after 6 to 8 weeks.

Potential Side Effects
  • Poor depth perception
  • Double vision that comes and goes
  • Halos and glares in bright lights
  • Blurry distance or near vision
  • Poor night vision
Cost

All types of LASIK surgeries are considered elective and are not covered by insurance. While the cost may vary depending on the facility, location, or your surgeon’s experience, expect to pay about $1,500 to $2,000 per eye.

2. Corneal Inlays (keratophakia)

Corneal inlays are implants that correct presbyopia.7 For reference, the cornea is the clear front part of the eye.

Corneal inlays are recommended for people with minimal refractive errors and without cataracts (cloudy eye lens). The inlay is fixed in the non-dominant eye.

The two main types of corneal inlays are:

  • Refractive corneal inlays. Similar to multifocal contact lenses with different levels of magnification. They enable focus on near and far objects.
  • Small aperture inlays. They’re donut-shaped and control the amount of light entering the eye, providing better vision at close range. A common example is the FDA-approved Kamra corneal inlay.8 

Inlays can be used in combination with LASIK to treat ametropia (myopia, hyperopia, or astigmatism).

Ideal Candidate

You qualify for corneal inlays if you’re:

  • Free from eye disease
  • Free from underlying health conditions that may interfere with the surgery
  • Free from refractive errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism (irregular cornea)
Procedure

The corneal inlay is an outpatient procedure done under topical anesthesia. During surgery, the eye surgeon will create a pocket-like incision on the cornea. They will then insert the inlay device and position it in the middle of the cornea. 

In some cases, the surgeon may create a flap (like in LASIK surgery) and place the inlay device before repositioning the flap. This procedure takes about 15 minutes or less.

After surgery, the surgeon will prescribe antibiotic eye drops to prevent infection. Initial recovery is quick, but most people recover fully in about 3 months.

Potential Side Effects
  • Halos, glare, and poor night vision
  • Loss of contrast sensitivity
  • Prolonged recovery if combined with LASIK
  • Dry eyes
  • Infection
  • Fluctuating vision
Cost

Expect to pay about $4,000 to $5,000 for corneal inlays. This cost varies depending on the facilities, location, or surgeon. Insurance may also cover surgery. Talk to your surgeon and insurance provider for more details.

3. Photorefractive Keratectomy (PRK)

PRK is a great alternative to LASIK. However, PRK is different from LASIK, which requires cutting into the cornea to create a foldable flap. A thick cornea is also not required for PRK. The procedure involves the removal of the corneal epithelium before laser treatment.9

Ideal Candidate

You qualify for PRK if you:

  • Have presbyopia
  • Have thin corneas
  • Have healthy eyes
  • Aren’t pregnant or nursing
  • Don’t have underlying conditions, such as diabetes that can affect healing
Procedure

During PRK, the surgeon will administer anesthetic eye drops and hold the eyes open using an eyelid holder. Next, they will remove the cornea’s outer layer (corneal epithelium) using a special blade, brush, and alcohol solution.

While you stare at a target light, the surgeon will carefully reshape the cornea using an excimer laser. You will hear a clicking sound as the laser corrects your vision.

After surgery, the surgeon will place bandage contact lenses on the corneas to prevent infection and enhance healing. They will also prescribe antibiotic eye drops and pain relievers.  

The surgery takes about 5 minutes per eye. Expect to feel better after a few days, but most people recover fully in about a month.

Potential Side Effects
  • Glare and halos around lights, especially at night
  • Corneal scarring
  • Corneal haze (cloudiness in the cornea)
  • Infections
Cost

The exact cost of PRK depends on your provider, location, and pre-and post-care services provided at the facility of choice. PRK is also considered an elective surgery. Expect to pay between $1,000 to $3,000 per eye.

4. Laser epithelial keratomileusis (LASEK)

LASEK is similar to PRK and a good alternative to LASIK.10 The only difference is that LASEK preserves the epithelium while PRK completely removes it to allow for a new one to grow.

Procedure

After administering local anesthesia, the surgeon will cut and remove the corneal epithelium (the cornea’s outer layer) and soften it with a diluted alcohol solution. They will then fold it back to expose the underlying corneal layer.

The corneal shape will be altered using the excimer laser, and the epithelial flap replaced afterward. The surgeon may place bandage contact lenses over the cornea to hold the epithelium in place to allow for healing. 

The procedure takes about 15 minutes per eye. Most people recover fully in about 6 to 9 months.

Ideal Candidate

You qualify for LASEK if you:

  • Are at least 18 years or older
  • Have stable vision for at least one year
  • Don’t have eye diseases, such as cataracts or glaucoma
  • Aren’t taking medications, such as steroids, that can affect healing
  • Are free of diseases, such as diabetes, that may interfere with healing
  • Want to stop wearing glasses and/or contacts
Potential Side Effects
  • Gritty eyes
  • Seeing halos around objects
  • Poor night vision
  • Some pain and discomfort after surgery
  • Dry eyes
  • Flap infections
  • Inflammation and infections
  • Sensitivity to light
Cost

The cost of LASEK is similar to LASIK and PRK. Although it may differ based on the facility, location, and other factors, expect to pay about $1,500 to $2,000 or more per eye.

5. Refractive Lens Exchange (RLE)

Refractive lens exchange (RLE) is another alternative to LASIK and PRK. It involves the removal of the natural eye lens and placement of an artificial intraocular lens (IOL) to improve vision.11 

RLE eliminates the need for glasses and contacts in people with presbyopia. It also has a long-lasting outcome.

Ideal Candidate

You qualify for RLE if you:

  • Have presbyopia
  • Don’t qualify for LASIK or PRK
  • Don’t want to wear glasses and/or contact lenses
  • Have healthy eyes
  • Are free of eye and body diseases that may affect surgery or healing
  • Are not taking medications that may affect surgery (e.g., blood thinners)
Procedure

Before RLE, the surgeon will administer local anesthesia to numb the eye and sedatives to help with relaxation.

Next, they will make a small incision to reach the lens. They will then use an ultrasound probe to break up and remove the lens fragments. This process is known as phacoemulsification

Once the fragments are removed, the surgeon will insert the artificial lenses. These lenses are foldable to allow easy fitting through the tiny opening. They unfold after being positioned correctly.

This procedure takes about 30 minutes, but you may have to stay for about two hours before you’re discharged. Usually, each eye is treated separately (one or two weeks apart).

A week after surgery, you can begin normal activities, but full recovery may take several weeks.

Potential Side Effects
  • Temporary blurring
  • Sensitivity to light
  • Halos, glares, and rings around lights
Cost

RLE is an elective surgery. Expect to pay anywhere from $2,500 to $4,500 or more per eye.

6. Conductive Keratoplasty

CK helps presbyopic people reduce their dependence on glasses. It involves the use of radiofrequency energy to reshape the cornea and improve focus.12 CK is less invasive than the procedures listed above.

Ideal Candidate

You qualify for conductive keratoplasty (CK) if you:

  • Are 40 years or older 
  • Have presbyopia 
  • Measure about +0.75 and +2.50 diopters of correction 
  • Have lower than 0.75 diopters of astigmatism 
Procedure

Like the other surgeries, the surgeon will administer local anesthesia to numb the eyes and prevent pain and discomfort. Next, they will mark the visual axis with a device known as a Sinsky Hook

Using a keratoplasty tip, the surgeon will send mild radiofrequency energy into the cornea. Doing so gently heats the upper layer of the cornea, causing it to shrink. The shrinkage enhances the cornea’s refractive power.

CK takes 5 minutes or less to complete. Most people notice improved near vision immediately after CK. However, full recovery may take a few weeks.

Potential Side Effects
  • Photophobia (sensitivity to light)
  • Gritty feeling in the eyes 
  • Fluctuating vision
  • Slight nearsightedness
  • Corneal regression
Cost

CK is considered an elective procedure. The cost varies depending on the facility, location, and the surgeon’s experience. You can expect to pay about $1,500 to $2,000 per eye.

Other Treatment Options for Presbyopia 

Below are other, less invasive treatments for presbyopia:

Reading glasses

If you only have presbyopia, eyeglasses can correct near vision. You can get these with or without a prescription. However, a professional eye exam will help determine the power of lenses you need.

Bifocals, Trifocals, or Progressive Lenses

If you wear eyeglasses to correct other vision problems, you may need bifocals, trifocals, or progressive lenses to correct presbyopia:

  • Bifocals. Correct both near and far vision. The lens is divided by a line into two areas. The top part bends light to enable distance vision, while the bottom part enables near vision.
  • Trifocals. These have three lens areas for close-up, mid-range, and far vision.
  • Progressive lenses. These have no segments unlike bifocals, but refractive power changes gradually from the top to the bottom of the lens.

Contact Lenses

Some people prefer contact lenses over eyeglasses. Two common types of contacts for presbyopia include:

  1. Monovision contacts. These correct one eye for distance vision and the other for near vision.13
  2. Multifocal contacts. These lenses have several zones with different refractive powers.

Can You Prevent Presbyopia?

No, presbyopia is not preventable. But you can still protect your eyes by:

  • Attending regular eye exams
  • Managing chronic health conditions 
  • Protecting your eyes from harmful sun rays (UV rays)
  • Protecting your eyes from injuries
  • Maintaining a healthy diet of fruits, leafy greens, and other vegetables
  • Wearing suitable eyeglasses
  • Avoiding poor lighting (turn up or add light for better vision)
  • Seeing your doctor immediately if you experience sudden vision loss, hazy vision, or double vision

Summary

Presbyopia (age-related farsightedness) is when the eyes lose the ability to focus on objects. It’s common in the early to mid-40s and worsens over time.

Symptoms can include: 

  • The inability to focus clearly on nearby objects
  • Squinting
  • Eye strain or headache after close-up activities
  • Frequent eye fatigue
  • Poor night vision

The different treatments for presbyopia include eyeglasses, contact lenses, and surgery. Surgeries include LASIK, refractive lens exchange (RLE), corneal inlays, PRK, LASEK, and conductive keratoplasty (CK).

Although presbyopia can’t be prevented, the risk can be reduced through regular eye check-ups, management of chronic illnesses, and protecting your eyes from injury and UV rays.

13 Cited Research Articles
  1.  Katada  Y. et al.,“Functional Visual Acuity of Early Presbyopia,” PlOS ONE, 09 Mar. 2016
  2. Presbyopia,” Mayo Foundation for Medical Education and Research (MFMER, 20 Nov. 2021
  3. Bonner W.,“Premature Presbyopia,” American Medical Association,  01 Dec. 1923
  4. Boyd K.,“What Is Monovision (or Blended Vision)?,” American Academy of Ophthalmology, 07 May. 2018.
  5. Boyd K.,“Depth Perception,” American Academy of Ophthalmology, 23 Mar. 2018
  6. LASIK eye surgery,” National Library of Medicine, 21 Mar. 2022\
  7. Sane M. et al.,“Corneal Inlays,” American Academy of Ophthalmology, 23 Sep. 2021
  8. Moshirfar M. and Wallace R., “The KAMRA Corneal Inlay in Practice,” Review of ophthalmology, 5 Oct.  2016
  9. Boyd K., “What Is Photorefractive Keratectomy (PRK)?,” American Academy of Ophthalmology, 27 Sept. 2017
  10. Azar D. and Taneri S.,“Laser Epithelial Keratomileusis,” Science Direct, 2007
  11. Alió G. et al.,“Refractive lens exchange in modern practice: when and when not to do it?,” National Center for Biotechnology Information (NCBI), Dec. 2014
  12. Vinciguerra, R.,“Conductive Keratoplasty,” American Academy of Ophthalmology, 18 Sept. 2021
  13. How can presbyopia be corrected?,” National Center for Biotechnology Information (NCBI), 04 Jun. 2020
Melody Huang is an optometrist and freelance health writer. Through her writing, Dr. Huang enjoys educating patients on how to lead healthier and happier lives. She also has an interest in Eastern medicine practices and learning about integrative medicine. When she’s not working, Dr. Huang loves reviewing new skin care products, trying interesting food recipes, or hanging with her adopted cats.
Vincent Ayaga is a medical researcher and experienced content writer with a bachelor's degree in Medical Microbiology. His areas of special interest include disease investigation, prevention, and control strategies. Vincent's mission is to create awareness of visual problems and evidence-based solutions shaping the world of ophthalmology. He believes that ophthalmic education offered through research has a greater impact among knowledge seekers.
https://www.visioncenter.org/author/vince/
Author: Vince Ayaga  | UPDATED May 3, 2022
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Medical reviewer: Dr. Melody Huang, O.D.
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Dr. Melody Huang, O.D.
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The information provided on VisionCenter.org should not be used in place of actual information provided by a doctor or a specialist.

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