When The Cornea Outperforms The Lens: Presbyond Vs Trifocals

To evaluate long-term outcomes of corneal laser blended vision (PRESBYOND) compared with trifocal intraocular lens implantation following refractive lens exchange (RLE) for presbyopia correction. With increasing demand for spectacle independence in middle-aged patients, both corneal and lens-based strategies are widely offered. However, RLE exposes patients to intraocular surgical risks and dysphotopsias that are usually overlooked by doctors and under estimated,  This presentation assesses whether a corneal approach can provide superior functional vision, safety, and patient satisfaction while avoiding intraocular complications.

Single high-volume tertiary refractive surgery center in Dubai (Al Zahra Hospital) United Arab Emirates. All procedures were performed by a single experienced surgeon over a seven-year period using standardized protocols and follow-up assessments.

Retrospective analysis of presbyopic patients undergoing PRESBYOND  laser blended vision compared with patients receiving bilateral trifocal IOL implantation via RLE. Outcomes included uncorrected distance, intermediate, and near visual acuity, contrast sensitivity, spectacle independence, dysphotopsia incidence, enhancement rates, and complication profiles. Patient-reported outcome measures and long-term satisfaction were analyzed. Surgical and postoperative complications related to intraocular surgery with trifocal IOLs

PRESBYOND achieved >98% functional success with high levels of spectacle independence and patient satisfaction. Compared with trifocal IOLs, the corneal approach demonstrated superior contrast sensitivity, fewer night-vision disturbances, and significantly lower rates of halos and glare. No intraocular complications occurred in the PRESBYOND cohort, whereas the RLE group experienced complications including posterior capsule opacification requiring YAG capsulotomy, dysphotopsia, residual refractive error, and lens exchange in selected cases.

Corneal presbyopia correction using PRESBYOND provides effective and predictable spectacle independence while avoiding the inherent risks of intraocular surgery. Compared with trifocal IOL implantation, the corneal approach demonstrated superior quality of vision and safety profile in appropriately selected patients. These findings support a cornea-first strategy for presbyopia correction in emmetropic and low hyperopic patients, reserving lens-based solutions for selected indications.