A patient from Oxnard asked me today about using the laser to correct near vision. Presbyopia is the age related loss of the ability to read up close — and it affects everybody eventually. Presbyopia occurs because the lens of the eye becomes less flexible with age and therefore  is less and less able to bulge to provide close up focus. There are several surgical solutions for presbyopia, but each of them has its limitations. Perhaps the most popular is LASIK for monovision or blended monovision in which the dominant eye is set for distance and the non-dominant eye is set for closer vision. Approximately 80% of people can adapt to, and benefit from, some degree of monovision or blended vision LASIK correction. Other approaches include corneal inlays such as KAMRA, Raindrop, or the Flexivue Microlens. Intraocular lens based surgical options include multifocal lens implants and flexible lens implants, but these approaches involve an increased level of risk since they involve operating inside of the eye. A very appealing option has been “PresbyLASIK” in which the excimer laser is used to sculpt a multi-focal correction into the surface of the eye (and therefore avoid the risks of operating inside of the eye). The multi-focal shape allows patients to see near and far simultaneous, even once presbyopia has set in.  PresbyLASIK continues to evolve and is not yet approved by the FDA. A colleague of mine, and one of the founders of modern LASIK,  Ian Pallikaris of Greece, recently led a review of scientific papers published on PresbyLASIK through the end of 2014. Dr. Pallikaris notes that the goal of PresbyLASIK is to replace the flexing action of the lens with a complex static shape on the corneal surface that can focus for both near and far. Because of this substitution of a dynamic property with a static property (like almost all presbyopia corrective surgery involves), he cautions, there is an inherent trade-off involved with PresbyLASIK — as there is with all surgical corrections of presbyopia. Dr. Pallikaris noted there are 3 treatment categories of PresbyLASIK: 1) “Central PresbyLASIK” which provides excellent near vision, but less safety; 2) “Peripheral PresbyLASIK” which provides excellent distance vision and safety, but compromises near vision more; and 3) “Laser Blended PresbyLASIK” which provides the best combination of far vision, near vision, and safety. Dr. Pallikaris also noted the importance of long term follow up to address any issues of neural adaptation (the patient’s brain adjusting to the PresbyLASIK) and also any late term healing of the PresbyLASIK’s ablation shape which could affect its performance. Dr. Pallikaris concludes his article by noting that, unlike with the LASIK we are more familiar with in the United States, PresbyLASIK is hard to undo at this point in case the patient is not satisfied and further research needs to be conducted into creating an “exit strategy” for those situations. In general, I consider PresbyLASIK to hold great potential for carefully selected patients, but it still is evolving and is not yet ready for routine use.