Special case : hyperopic presbyope → PRELEX often the most suitable.
Indicative price : 3000-4000 € per eye for PRELEX.
Key point : presbyopia is not prevented by previous LASIK, it will appear regardless.
Understanding
What is presbyopia exactly?
Until age 40, the crystalline lens is supple and elastic. It changes shape constantly to focus, near and far. This is accommodation: an automatic, instantaneous mechanism we are never aware of because it works perfectly.
With age, the crystalline lens progressively hardens. It loses its capacity to deform. Near focus becomes difficult, then impossible without correction. It is not the eye ageing badly: it is a programmed biological process, unavoidable, that affects everyone.[1]
Around 35. The lens is flexible. It rounds up to focus, and the image of a near object forms exactly on the retina.
After 45. The lens has stiffened. It no longer rounds up enough, the image forms behind the retina, and near vision turns blurry.
Presbyopia progresses until around age 65, when the crystalline lens is totally rigid. That is why the timing of surgical correction is an important and personalised decision.
What it changes in daily life
Arms too short. Holding your phone, your book, your menu further and further away to read. Until even at arm's length, it is no longer enough.
The glasses ritual. Taking them off to read, putting them back on to look far away. Several times an hour. Looking for them everywhere.
End-of-day fatigue. Burning eyes after a day on screens. The brain compensating for a defect the eye can no longer correct alone. A real cognitive fatigue, often underestimated.
Professional impact. Meetings where you no longer dare to read your notes without glasses. Presentations where you juggle between two pairs. A progressive daily constraint.
Presbyopia and other refractive errors. Presbyopia often superimposes on pre-existing myopia, hyperopia or astigmatism. This combination complicates optical correction. That is precisely where surgery offers a comprehensive solution that glasses cannot match.[2]
Surgical options
PRELEX (lens replacement). For the hyperopic presbyope over 45. The natural crystalline lens, now rigid, is replaced by a multifocal or trifocal implant. Treats presbyopia, hyperopia simultaneously and prevents future cataract.
Laser monovision. One eye corrected for distance, the other for near. An option between 40 and 50 depending on the profile. Requires a prior contact lens trial to evaluate neurological tolerance.
Presbyopia and cataract
After age 60, the question is no longer just presbyopia but the state of the crystalline lens as a whole. An early cataract may accompany presbyopia. The biometric exam evaluates the state of the lens and guides towards the solution best suited to the overall clinical picture.
The timing of surgeryThere is no universal ideal age. Between 45 and 55, PRELEX is often discussed. The decision depends on the overall refractive profile, the state of the crystalline lens and the patient's visual expectations.
References
Glasser A, Campbell MC. Biometric, optical and physical changes in the isolated human crystalline lens with age in relation to presbyopia. Vision Res. 1999;39(11):1991-2015.
Yes, with monovision: one eye is corrected for distance vision, the other for near vision. PRELEX is often preferred after age 50.
Are PRELEX and cataract surgery the same?
Technically yes. The difference is the context: in cataract, the crystalline lens is opacified. In PRELEX, it is still transparent but rigid, and it is replaced to correct presbyopia and refractive errors.
From what age can PRELEX be considered?
Generally after 45-50 years of age, when presbyopia is well established. The exam evaluates the exact state of the crystalline lens and helps determine the right timing.
Can early presbyopia be operated on?
Presbyopia surgery is more effective when the defect is well established, generally after age 48-50. Operating too early has the drawback of working on a lens that still retains some residual flexibility. The preoperative exam helps determine whether the profile is ready for surgery or whether it is better to wait a few years.
Does presbyopia come back after a PRELEX procedure?
No. PRELEX replaces the natural crystalline lens with an artificial implant that does not age. Presbyopia cannot recur on an artificial lens. This is one of the major advantages of PRELEX over laser monovision techniques, which reshape the cornea while the crystalline lens goes on stiffening.
Is laser monovision an alternative to PRELEX?
Laser monovision is an option I evaluate on a case-by-case basis. It consists of correcting one eye for distance vision and the other for near vision. It suits certain profiles, but its result is less natural than a multifocal implant. The preoperative exam helps determine which solution is most consistent with your correction and your lifestyle.
Daily life
Presbyopia and screens: the double problem
Presbyopia arises precisely at the age when screen use intensifies in working life. The rigid crystalline lens struggles to focus up close, and the brain must compensate for a defect the eye can no longer correct alone. This invisible work generates real cognitive fatigue at the end of the day: burning eyes, lapsing concentration, frontal headaches.
Many patients attribute these symptoms to fatigue or stress, without making the link with their presbyopia. A complete ophthalmic exam allows the correct diagnosis to be made and helps evaluate whether a correction (optical or surgical) can significantly change daily comfort.
Presbyopia and driving are also a point of vigilance. Switching between the dashboard, the road and signs constantly requires focus at varied distances. When the crystalline lens no longer accommodates freely, these constant adjustments become uncomfortable, even a source of fatigue on long journeys.
A SIMPLE STEP TO MOVE FORWARD
If you recognise some of these symptoms (arms too short, glasses you search for everywhere, end-of-day fatigue), an initial consultation allows the solution suited to your profile and lifestyle to be assessed in 45 minutes. It is available within one to two weeks in Brussels. At this first meeting, you leave with a clear answer on your eligibility and, if you are a candidate, a precise timeline for what comes next.
Author of this page
Dr Serdal Sanak
Ophthalmic surgeon · Refractive and cataract surgery
CHIREC Hôpital Delta, Brussels
Graduated from the ULB, trained at CHU de Liège and CHIREC. European Diploma in Ophthalmology (FEBO). Refractive and cataract surgery make up the bulk of my operating activity, with procedures every week at CHIREC Delta. Dual specialisation: corneal laser surgery (Femto-LASIK, PRK) and intraocular surgery (ICL, PRELEX, cataract). Consultations in French, Dutch, English, Turkish, Kurdish, Persian and Italian.
