[Presbyopia and refractive surgery]

Presbyopia is the progressive loss of accommodation. Accommodation is a quick, precise and involuntary action which enables the eye to change the power of the young crystalline lens to see clearly at all distances. Presbyopia is and age-linked physiologic phenomenon: it results from aging of the lens, which loses its elasticity, gradually becomes rigid and loses the ability to accommodate. Presbyopia has attained a prevalence of 80% in Europe and is increasing regularly due to the aging of the population. Various surgical techniques can be proposed. Indications depend on age, ophthalmological exam, and any associated ametropia. The main techniques act by either changing the curvature of the cornea with laser or with an intrastromal inlay to create pseudoaccomodation, or by intraocular lens surgery with a multifocal or accommodating IOL. Once the surgical choice has been made, the information must be clearly conveyed and consent obtained.