The Surgical Reversal of Presbyopia: A New Procedure to Restore Accommodation

Surgical reversal of presbyopia (SRP) can be called the last frontier in the attempt to correct refractive and optical disorders. Modern refractive surgery began approximately 50 years ago when José Barraquer of Bogotá, Columbia developed keratomileusis. Other procedures to alter the optical and focusing mechanism of the eye followed. This included radial and astigmatic keratotomy, hexagonal keratotomy, thermokeratoplasty, automated lamellar keratoplasty, intrastromal corneal lenses, epikeratophakia, intacs, clear lens extraction, multifocal intraocular lenses (IOLs), phakic IOLs (including intraocular “contact lenses”), photorefractive keratectomy (PRK), laser in situ keratomileusis (LASIK), and laser computer-generated multifocal corneal correction. All of these have been used to alter the cornea or change the focusing powers of the ocular system. The only methods to date that helped those experiencing presbyopia was the use of monovision (correcting one eye for near and one eye for distance), using any of the aforementioned techniques of refractive surgery on one eye, or the use of optical devices such as a single contact lens, bifocal lenses, or reading glasses. These were all compensatory. No procedure up to this time has been able to reverse presbyopia and actually restore the natural focusing mechanism. This would be independent of those methods used at this time to compensate for the loss of the accommodative near focusing powers of the eye. For the last 150 years, the explanation of the loss of accommodation through Helmholtz’s theory has been included in the medical textbooks. It has been described as the lens hardening with aging. This decrease in flexibility of the lens and the loss of elasticity of the lens