This article is sponsored by EuroEyes Laser Eye Clinic London to share insights about the refractive surgery known as PRESBYOND.

Presbyopia is a natural part of ageing that affects near vision, making everyday tasks like reading or using a phone more challenging¹. While options like varifocals, multifocal contact lenses, and monovision corrections are common, they don’t suit everyone. This is where PRESBYOND, a proprietary laser eye surgery from Zeiss Meditec², becomes a useful addition to an optometrist’s arsenal of suggestions – especially for those patients who also express an interest in refractive surgery.

PRESBYOND offers patients clear vision across near, intermediate, and distance ranges by reshaping the cornea with precision. Unlike traditional monovision, it provides a smoother and more comfortable visual experience. It’s a valuable alternative for those wanting more freedom from glasses or contact lenses.

I first came across PRESBYOND at EuroEyes Laser Eye Clinic London whilst visiting an ophthalmologist colleague (Dr Fadi Akherdaji) in late 2024. Whilst on-site I heard many positive testimonials from his patients about how PRESBYOND has improved not only their vision, but their lives overall.

With this option previously sitting in my blind spot, I felt I should also make others aware of its existence, whilst highlighting that refractive surgery is now a much more attractive option for presbyopic patients than it has been historically. As professionals, we need to ensure we offer the most suitable options for our patients^3,4 and, for some, PRESBYOND may be the right option. This article explains how the procedure works, its benefits, and who might consider it.

What is PRESBYOND?

PRESBYOND is a proprietary laser eye surgery developed by Professor Dan Reinstein and Carl Zeiss Meditec in 2009⁵, designed specifically to address presbyopia. It offers a modern approach to correcting near vision issues by reshaping the cornea. Unlike standard monovision techniques, PRESBYOND creates a “Blend Zone” that allows for a smoother transition between near, intermediate, and distance vision.

The procedure takes advantage of advanced excimer laser technology², to customise the treatment for each patient. By carefully adjusting the dominant eye for distance and the non-dominant eye for near, Presbyond provides an extended depth of focus². This unique method reduces the abrupt transitions and adaptation challenges often associated with traditional monovision, creating a more natural visual experience^6,7.

How Does PRESBYOND Work?

The PRESBYOND process starts by identifying the dominant eye (primarily used for distance vision) and the non-dominant eye (optimised for near and intermediate tasks, being left slightly myopic by approximately -1.50 dioptres^2,5). The laser is then used to reshape the cornea in each eye accordingly.

Unlike traditional methods, PRESBYOND ensures that both eyes contribute to the visual outcome, enhancing binocular vision (how the eyes work together as a pair). This reduces the abrupt transitions and stereopsis (depth perception) issues often found with monovision techniques.

A key element of PRESBYOND’s success lies in its controlled manipulation of spherical aberration^5,6,7,8. Normally considered a visual flaw^9,10,11, spherical aberration occurs when light rays entering the outer edge of a lens or cornea focus differently from those entering near the centre^10,11. This can cause blurriness or sub-optimal focus¹⁰.

PRESBYOND uses this phenomenon to its advantage¹¹. By introducing a carefully measured amount of spherical aberration, it increases the depth of focus for each eye. This expanded focus range allows for seamless transitions between different distances, making near and intermediate tasks more comfortable and natural for patients⁵.

Presbyond represents a significant step forward in refractive surgery for presbyopia, as the technique helps ensure the patient retains their binocular vision and has little effect on their contrast sensitivity¹². Its tailored approach ensures improved vision without compromising on patient comfort or satisfaction.

A Little More on Spherical Aberrations

Spherical aberration occurs when light entering the outer edges of a lens or cornea focuses at a different point compared to light passing through its centre^10,11. This happens because the curved surface bends peripheral light rays more than central ones, leading to a spread-out focal point rather than a sharp image. In natural vision, this can cause blurry or distorted edges in what we see^10,11.

In optics and refractive surgery, spherical aberration is often viewed as a flaw to be corrected. However, it can also be harnessed in certain procedures. By carefully introducing spherical aberration in a controlled way, the depth of focus can be increased¹¹. This approach enables the eye to achieve clearer vision over a broader range of distances.

For PRESBYOND, this phenomenon is manipulated to enhance the Blend Zone⁵, offering smooth transitions across near, intermediate, and distance vision. It’s a smart use of optics for practical outcomes¹¹.

Benefits of PRESBYOND Over Other Methods

PRESBYOND offers several advantages over traditional ways of managing presbyopia. By tailoring the procedure to each patient, it provides a seamless visual experience that stands apart from other options.

Compared to Spectacles: While varifocals and reading glasses are practical for many, PRESBYOND provides additional freedom for patients with active lifestyles. By reducing reliance on glasses, PRESBYOND offers a more convenient and liberating alternative.

Compared to Contact Lenses: Multifocal contact lenses can be effective but come with challenges like discomfort, dryness, and adaptation difficulties. Not everyone can tolerate lenses for extended periods, and their performance may fluctuate depending on lighting conditions. PRESBYOND eliminates these issues by delivering consistent and tailored visual correction².

Compared to Other Refractive Surgeries: Monovision LASIK is a common surgical option, but it involves correcting one eye for distance and the other for near vision, which can lead to loss of depth perception and stereopsis¹². Multifocal IOLs split light into different focal points, which may result in halos¹³ or reduced contrast sensitivity¹³, particularly at night. PRESBYOND’s Blend Zone reduces these drawbacks by creating a gradual and natural transition across all visual ranges².

With PRESBYOND, patients may experience better intermediate vision and smoother adaptation while avoiding many of the visual disturbances linked to other techniques^5,6. This makes it a strong choice for those seeking a comfortable, all-encompassing solution to presbyopia correction.

As optometrists, it is important to remember that we play a vital role in advising patients about all suitable options, whether it’s PRESBYOND or other presbyopia solutions. You should always ensure that you recommend the right options for your patients’ needs^3,4.

Ideal Candidates for PRESBYOND

PRESBYOND is suitable for many patients with presbyopia, but the best results come from carefully selecting the right candidates. As optometrists, we are well positioned to identify these candidates and advise them accordingly.

Ideal candidates include those aged 40 to 60^2,5, with symptoms of presbyopia and good overall eye health². Patients with low to moderate refractive errors (up to -8.00 dioptres of myopia or +2.00 dioptres of hyperopia^2,5) tend to be suitable, as PRESBYOND can address these ametropias alongside their presbyopia. A stable prescription is essential, as fluctuating vision can affect outcomes. Additionally, adequate corneal thickness is needed to safely perform the laser ablation process.

Individuals who have adapted to monovision (through contact lenses, for example) may find PRESBYOND a smoother and more comfortable alternative, thanks to its Blend Zone⁵. However, it’s also an option for those new to refractive solutions, as the procedure is designed to minimise adaptation challenges².

Contraindications include significant dry eye, corneal irregularities⁵, or underlying eye diseases like keratoconus or cataract^5,14. Patients with unrealistic expectations or those unlikely to adapt to neuroadaptation may not be ideal⁵.

For eligible individuals, this procedure offers an exciting opportunity to regain freedom from traditional correction methods while enjoying clearer vision across all distances.

Risks and Considerations

As with any medical procedure, PRESBYOND has risks that need to be considered alongside its many benefits. Whilst the procedure is considered safe⁸, with most patients experience smooth recovery and excellent results, it’s important to discuss potential side effects to ensure realistic expectations.

Temporary symptoms like halos, glare, or reduced contrast sensitivity are possible, particularly in low-light conditions⁵. These effects are generally short-lived and improve as the brain adapts to the new visual system. Dry eye symptoms can also occur postoperatively but are usually manageable with eye drops or other treatments.

Remember, not everyone is an ideal candidate for refractive surgery or PRESBYOND. Patients with severe dry eye⁵, corneal irregularities⁵, or retinal issues may be unsuitable. Additionally, those with unstable prescriptions or unrealistic expectations about the procedure’s outcomes might need to explore other solutions⁵. Those with high visual demands or are known to be frequently non-tolerant to spectacle updates may also be poor candidates.

Careful preoperative assessments, including corneal topography, pachymetry and a review of ocular health, are essential to minimise risks and determine patient suitability.

While no surgery is without potential complications, PRESBYOND has an excellent safety record when performed by experienced surgeons. Ensuring patients fully understand both the benefits and considerations allows for informed decisions and optimal outcomes. Referring your patients to trusted providers like EuroEyes Laser Eye Clinic London guarantees they receive the highest level of care from experienced professionals.

Why Consider EuroEyes Laser Eye Clinic London?

When I first visited EuroEyes Laser Eye Clinic London in late 2024, I was struck by the clinic’s commitment to excellence. The facilities were modern and impressive, with an operating theatre that felt like stepping into the future. The staff were welcoming and knowledgeable, taking time to explain the details the procedures they perform and how they support each patient on their journey.

During the open event, I had the chance to speak with patients who had undergone PRESBYOND surgery. Their testimonials stood out – as many shared how the procedure had improved their quality of life, giving them clearer vision and freedom from glasses. Hearing their experiences confirmed the value of this treatment and inspired me to share it with others.

For patients considering refractive surgery, or optometrists looking to expand treatment options for their presbyopic patients, EuroEyes Laser Eye Clinic London offers a modern, patient-centred approach worth exploring. Why not visit their website today and see how they can help you, or your patients that are requesting refractive surgery?

I would once again like to thank EuroEyes Laser Clinic London for not only sponsoring this post, but for allowing me the opportunity to visit your clinic and for the additional information about the extensive services that you offer.

Further Reading

Further information regarding PRESBYOND is available on the EuroEyes Laser Eye Clinic London website – including information on other refractive surgery options that they offer.

Sources used in addition to the information provided by EuroEyes to aid the construction of this article can be found below:

1. Singh P, and Tripathy K (2023). Presbyopia. StatPearls [Online]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK560568/ [Accessed on: March 21st 2025].
2. Zeiss Meditec. Zeiss PRESBYOND: Laser correction for patients with presbyopia. Zeiss. [Online] Available at: https://www.zeiss.com/meditec/en/products/refractive-lasers/excimer-laser/presbyond.html [Accessed on: March 21st 2025].
3. General Optical Council (2025). Standards of practice for optometrists and dispensing opticians. General Optical Council [Online]. Available at: https://optical.org/optomanddostandards/ [Accessed: March 21st 2025].
4. Searle J (2025). Professionalism in optometry. The Eye Care Advocate. [Online] Available at: https://theeyecareadvocate.co.uk/2025/01/06/professionalism-in-optometry/ [Accessed: March 21st 2025].
5. Jones N, O’Donnell C, Sisó-Fuertes I, and Hamid A (2023). Case study: PRESBYOND – laser blended vision. Optician Online [Online.] Available at: https://www.opticianonline.net/content/features/case-study-presbyond-laser-blended-vision/ [Accessed: March 21st 2025].
6. Reinstein D, Carp GI, Archer TJ, and Gobbe M (2012). LASIK for presbyopia correction in emmetropic patients using aspheric ablation profiles and a micro-monovision protocol with the Carl Zeiss Meditec MEL 80 and VisuMax. Journal of Refractive Surgery 28(8): 531-541.
7. Reinstein DZ, Archer TJ, Gobbe M (2011). LASIK for myopic astigmatism and presbyopia using non-linear aspheric micro-monovision with the Carl Zeiss Meditec MEL 80 Platform. Journal of Refractive Surgery 27(1), 23-37.
8. Messerschmidt-Roth (2023). Corneal refractive surgery for presbyopia: why ZEISS PRESBYOND was our preferred solution. Ophthalmology Times Europe [Online]. Available at: https://europe.ophthalmologytimes.com/view/corneal-refractive-surgery-for-presbyopia-why-zeiss-presbyond-was-our-preferred-solution [Accessed: March 21st 2025].
9. Marín-Franch I, Renfeng X, Bradley A, Thibos LN, and López-Gil N (2017). The effect of spherical aberration on visual performance and refractive state for stimuli and tasks typical of night viewing. Journal of Optometry 11(3): 144-152.
10. Barden A (2021). Spherical aberration: causes, diagnosis and treatment. All About Vision [Online]. Available at: https://www.allaboutvision.com/conditions/spherical-aberration/ [Accessed: March 21st 2025]
11. Skrzypecki J, Izdebska J, Ordon AJ, Przybek-Skrzypecka and Szaflik JP (2023). Spherical aberrations and their role in modern ophthalmology. Clinical and Experimental Optometry 106(7): 703-710.
12. Ivory E, Chorley A, Archer TJ, Vida RS, Gupta R, Lewis T, Carp GI, Fonseca A and Parbhoo M (2023) PRESBYOND Laser Blended Vision LASIK in commercial and military pilots requiring class 1 medical certification. Journal of Refractive Surgery 39(1): 6-14.
13. Dermott J (2022). Modern management of presbyopia: part 3: surgical methods. Dispensing Optics Sept 2022: 1-8.
14. Gil-Cazorla R, Shah S, and NarooSA (2016). A review of the surgical options for the correction of presbyopia. British Journal of Ophthalmology 100(1): 62-70.

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