Presbylasik : Supracor
Dr Mohita Sharma
Corneal approach to correct presbyopia is an attractive alternative which is minimally invasive. Supracor (Technolas Perfect Vision GmbH) is a new-generation excimer laser treatment for presbyopia. It aims to improve both distance, intermediate and near vision by using a unique multifocal ablation profile, thereby providing an aberration optimized smooth transition from distance to near correction.
It enhances near vision by creating a “bump” in the central 3 mm zone. The distance zone from 3 mm to 6 mm is left virtually untouched to create a smooth transition from near to distance. The new Supracor software is such that the transition zone is smoother thus decreasing chances of glare and haloes.
Supracor works on the principle that while reading the pupil constricts and only the central 3mm is used for reading. While viewing for distance the pupil dilates allowing 3mm to 6 mm function for distance. A slight compromise happens to the distance vision as some light also passes through the central 3mm in distance viewing. Hence it ispreferrable to do a monocular Supracor in the non dominant eye or the eye with poorer vision.
Though Supracor works on creating a multifocal corneal profile, the issues of multifocality like glare, haloes, loss of contrast are not seen as there is only one step compared to multiple steps with multifocal IOLs.
Ideal for hypermetropic patients with near addition of +1.5D or more, there is a separate nomogram for myopia as well.Supracor requires less adaptation to new vision and faster improved visual outcomes as against monovision approach which requires longer adaptation times.
Presbyond is another treatment platform for presbyopia correction, which works by inducing spherical aberration thereby increasing depth of focus. However there can be a high individual variability when we induce aberrations. Unless we link the software with adaptive optics which simulate the aberrations expected to be induced, results cannot be very satisfactory.
All presbylasik options are as yet slight compromises but Supracor with its initial results in 28 patients appears as a promising technology.