Key Messages

• Based on current evidence, the relative benefits and risks of different types of surgery for treating people with presbyopia (difficulties in reading or seeing close up) are unclear at three to six months after treatment. There was no information about the effects beyond six months after treatment.

• No study looked at the balance of costs and how well the different treatments worked.

• Future well-designed studies should measure the longer-term benefits and risks of different types of surgery for improving vision in people with presbyopia. They should also assess the impact on well-being, the ability to distinguish between small differences in light and dark (contrast sensitivity), and visual disturbances.

What is presbyopia?

Presbyopia refers to the inability of the eye to focus at different distances, which occurs with aging. People with presbyopia gradually lose the ability to see clearly at near distances (close up, e.g. reading) or at intermediate distances (e.g. using a computer). This condition eventually affects everyone and may significantly impact their well-being, regardless of their literacy or profession.

How is presbyopia treated?

Optical correction for presbyopia includes using glasses or contact lenses to improve vision at near and intermediate distances. However, these approaches have limitations and may not be appropriate for everyone. These shortcomings, added to increasingly demanding visual requirements for tasks at near and intermediate distances, have led to the development of several surgical options for presbyopia correction. Most available types of surgery change the shape of the cornea (the clear outer layer that covers the front of the eye) or replace the natural intraocular lens with an artificial one, known as an intraocular lens (IOL).

What did we want to find out?

We wanted to see whether there is any difference in effectiveness and safety between the available surgical options for correcting vision at near distance (i.e. at 40 cm from the eye) and intermediate distance (i.e. at 63 to 80 cm from the eye), and whether one or other treatment leads to better well-being for people with presbyopia. We also wanted to summarize relevant cost comparisons of the different surgical options for treating presbyopia.

What did we do?

We searched for studies that compared surgical options for people with presbyopia. We summarized the results reported by the studies and rated our confidence in the evidence, based on factors such as study methods and numbers of people treated.

What did we find?

We found four relevant studies. They were conducted in Croatia, Egypt, and Turkey, and treated 300 people (600 eyes) with presbyopia without cataracts or other problems. None of the studies included people with previous corneal or intraocular surgery. Two studies lasted for three months and two lasted for six months. One study reported that it received no funding and had no financial conflict of interest; the others did not provide this information. No study assessed the cost aspects of surgical treatments for presbyopia.

Two studies compared the implantation of two different IOLs; one compared the implantation of an IOL versus corneal refractive surgery (i.e. a surgical technique that uses a laser to modify the cornea); and another compared a modified versus conventional corneal refractive surgery.

Main results

We could not combine the results of the four studies because each study used different treatments and reported effects at different times after surgery.

In one study, people treated with corneal refractive surgery were slightly less likely to still need glasses for intermediate distances six months after surgery than those who underwent an IOL implantation. However, the people who had corneal refractive surgery were also younger, so would be expected to have less severe presbyopia, and therefore better intermediate vision.

As most studies did not report the impact on well-being, contrast sensitivity, or visual disturbances, we are uncertain about how different types of surgery affect these. There was no information about people with pseudophakic presbyopia (people whose natural lens has been replaced by an artificial lens that corrects distance vision but not close-up vision, which is why it is known as monofocal IOL) or those with previous corneal refractive surgery. The review findings highlight the need for more research in this area regarding current surgical options and comparisons of results over longer follow-up periods.

What are the limitations of the evidence?

We have little confidence in the evidence because it was unclear how studies were conducted and because we found only one relevant study for each pairwise comparison of surgical options.

How up-to-date is this evidence?

The evidence is up-to-date as of 29 February 2024.