Lens Fitting Research Articles

Visual and ocular surface benefits of mini-scleral contact lenses in patients with chronic ocular graft-versus-host disease (GvHD)

Graft-versus-Host disease is a major complication of allogeneic stem cell transplantation. The eyes are a frequently affected organ with a severe dry eye disease being the hallmark manifestation. This retrospective study evaluates the effect of mini-scleral contact lenses on visual acuity, eye-related quality of life and the ocular surface. 62 eyes of 31 patients were included and visual acuity, ocular surface disease index (OSDI) questionnaire results and Oxford grades before and after mini-scleral lens fitting were compared. Median Snellen fraction with mini-scleral lenses was 20/25 (1st 20/30/3rd 20/20) compared to 20/40 median Snellen fraction with spectacles (1st 20/60/3rd 20/25). Median OSDI scores improved from 73 (1st 41.6/3rd 89) before fitting to 27 (1st 14.5/3rd 56) with mini-scleral lenses. Median Oxford grade decreased from 3 before mini-scleral lens fitting (1st 1/3rd 4.75) to 1 after mini-scleral lens fitting (1st 0/3rd 4). Median time of follow up was 717.5 days. Seven patients (22.6%) discontinued therapy with mini-scleral lenses. Mini-scleral lenses are beneficial for most patients with ocular GvHD as they improve visual acuity, eye-related quality of life and the integrity of the corneal epithelium.

An integrative predictive model for orthokeratology lens decentration based on diverse metrics.

To develop a predictive model for orthokeratology (Ortho-K) lens decentration 1 month after wear. This study included myopic children who were fitted with Ortho-K lenses at Fujian Provincial Hospital between December 2022 and May 2024. Corneal topography parameters and other relevant metrics were collected pre- and post-treatment. Feature selection was conducted using univariate logistic regression and Lasso regression analysis. A machine learning approach was used to develop multiple predictive models, including Decision Tree, Logistic Regression, Multilayer Perceptron, Random Forest, and Support Vector Machine. Model performance was evaluated using accuracy, sensitivity, specificity, ROC curves, DCA curves, and calibration curves. SHAP values were employed to interpret the models. The Logistic Regression model demonstrated the best predictive performance, with an AUC of 0.82 (95% CI: 0.69-0.95), accuracy of 77.59%, sensitivity of 85%, and specificity of 61.11%. The most significant predictors identified were age, 8 mm sag height difference, 5 mm Kx1, and 7 mm Kx2. SHAP analysis confirmed the importance of these features, particularly the 8 mm sag height difference. The Logistic Regression model successfully predicted the risk of Ortho-K lens decentration using key corneal morphological metrics and age. This model provides valuable support for clinicians in optimizing Ortho-K lens fitting strategies, potentially reducing the risk of adverse outcomes and improving the quality of vision for patients. Further validation in clinical settings is recommended.

Impact of Scleral Lenses on Visual Acuity and Ocular Aberrations in Corneal Ectasia: A Comprehensive Review.

Corneal ectasias, including keratoconus (KC), pellucid marginal degeneration (PMD), and post-LASIK ectasia, poses significant visual rehabilitation challenges due to the resultant irregular astigmatism, myopia, and higher-order aberrations (HOAs). These conditions often resist traditional corrective methods, necessitating advanced optical solutions. Scleral lenses (SLs) have emerged as a primary non-surgical option for managing these complex corneal irregularities. SLs form a smooth optical interface by forming a tear-filled chamber between the lens and the cornea, effectively mitigating HOAs and improving both high-contrast and low-contrast visual acuity (VA). This review evaluates the efficacy of SLs in enhancing VA and reducing aberrations in patients with corneal ectasia. It also explores the technological advancements in SLs, such as profilometry and wavefront-guided systems, which enable more precise and customized lens fittings by accurately mapping the eye's surface and addressing specific visual aberrations. The current body of evidence demonstrates that custom SLs significantly improve visual outcomes across various ectatic conditions, offering superior performance compared to conventional correction methods. However, challenges such as the complexity of fitting and the need for precise alignment remain. Ongoing innovations in SL technology and customization are likely to further enhance their clinical utility, solidifying their role as an indispensable tool in the management of corneal ectasias.

Acquired Ankyloblepharon Correction Using Ocular Surface and Tarsal Mucous Membrane Grafting in Cicatrizing Ocular Surface Diseases

Purpose: To report the long-term surgical outcomes of acquired ankyloblepharon correction using mucous membrane graft. Methods: Five eyes of 4 patients (median age, 19 years) with acquired ankyloblepharon were managed using eyelid splitting and mucous membrane graft anchored to the recti muscles on the bulbar surface in the respective quadrant and onto the bare tarsal surface. Outcome measures include a change in the palpebral fissure width, ability to fit scleral contact lenses, visual acuity, and cosmesis. Results: The underlying etiologies of ankyloblepharon were chronic Stevens-Johnson syndrome (n = 3), and chemical injury (n = 2). All 5 eyes had conjunctival shortening, and 3 had severe dry eyes (median Schirmer 4.5 mm). Four eyes had limbal stem cell deficiency. The median horizontal palpebral fissure width improved to 22 mm from 8 mm. This single-staged surgical technique allowed for fornix formation and prosthetic replacement of the ocular surface ecosystem lens fitting in all 5 eyes. Median logMAR visual acuity improved from 2.1 to 0.7 following ankyloblepharon release, prosthetic replacement of the ocular surface ecosystem lens fitting in 4 eyes, and keratoprosthesis in 1 eye. Repeat mucous membrane graft for recurrent symblepharon in 1 quadrant was required in 2 eyes where complete 360 degrees bulbar and tarsal conjunctiva loss were present preoperatively. At the median follow-up period of 27 months, all patients reported better cosmesis and had no symblepharon recurrence following repeat surgery in 2 eyes and single surgery in 3 eyes. The donor site healed well without any complications. No mitomycin C or symblepharon ring was used. Conclusion: Ocular surface and adnexal reconstruction using bulbar and tarsal mucous membrane grafts help visually rehabilitate patients with acquired ankyloblepharon secondary to cicatrizing ocular surface disorders.

Multifocal contact lenses. Easy fitting algorithm and new possibilities in presbyopia correction with TOTAL30 Multifocal

Multifocal soft contact lenses are the fastest growth segment in contact lenses. While presbyopic patients demonstrate an increasing interest in contact lenses, not all practitioners actively integrate multifocal lenses into their practices. Some of the reasons include the perception that multifocal fitting is time-consuming and chances of successful adaptation of “ageing” patients are low. The purpose of this publication is to provide an overview of the latest multifocal contact lens, essential fitting steps and instruments for quick and effective multifocal lens fitting.

Changing indications for keratoplasty: monocentric analysis of the past two decades

Abstract Purpose Over the past two decades, lamellar keratoplasty procedures, such as Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) and Descemet's Membrane Endothelial Keratoplasty (DMEK) as well as Deep Anterior Lamellar Keratoplasty (DALK), have become an integral part of clinical practice. With advances in contact lens fitting for keratoconus management and the implementation of UVA-Riboflavin Crosslinking (CXL), the landscape of keratoplasty indications is undergoing changes. Procedures and indications in a single tertiary care center over the past two decades are reviewed in this retrospective analysis. Methods: Retrospective analysis utilized anonymized electronic data from the LIONS cornea bank Baden-Württemberg, Eye Center Freiburg, spanning from beginning of 2004 to end of 2023. The primary focus was on surgical procedures and indications for keratoplasty. Results The study encompassed a comprehensive analysis of 7130 corneal transplants. Penetrating keratoplasty (PK) exhibited a significant decline from 95% (n = 206, 2004) to 11% (n = 46, 2023), while DMEK increased from 48% (n = 157, 2012) to 82% (n = 347, 2023). Fuchs endothelial dystrophy (FED) emerged as the dominant indication, witnessing a significant increase from 24% (2004, n = 39) to 72% (2023, n = 288). Conversely, keratoconus (KC) showed a reciprocal change from 25% (2004, n = 40) to 4% (2023, n = 17). PK demonstrated a noteworthy indication shift in descending order from Bullous Keratopathy (BK), FED, and KC in 2004 to KC, graft failure, corneal scars, and ulcers in 2023. Repeat keratoplasty following DMEK remained rare, but a discernible upward trend was observed for PK. Conclusion This retrospective analysis highlights significant changes in both keratoplasty indications and techniques over the past two decades. DMEK has emerged as a successful intervention for treating endothelial diseases, while PK retains its qualitative indispensability for a wide range of indications. Modern corneal banks are urged to maintain a robust supply of grafts for all surgical techniques in anticipation of potential increased demand in the future, particularly for repeat keratoplasties. Key messages What is known • Over the past two decades, lamellar keratoplasty procedures such as DSAEK and DMEK have increasingly replaced penetrating keratoplasty (PK) in clinical practice due to their improved outcomes and reduced complications for certain indications. New Findings • Our study reveals a significant shift in keratoplasty indications, with Fuchs endothelial dystrophy (FED) emerging as the predominant indication, increasing from 24% in 2004 to 72% in 2023, while keratoconus (KC) declined from 25 to 4% during the same period. • Penetrating keratoplasty (PK) has shown a marked decline in use, dropping from 95% of keratoplasties in 2004 to 11% in 2023, whereas DMEK has grown to represent 82% of procedures in 2023. • Despite the rise of DMEK, PK remains vital for a broad spectrum of indications, highlighting the necessity for corneal banks to maintain a versatile supply of grafts to meet diverse clinical needs, particularly in cases of repeat keratoplasties.

International trends in prescribing silicone hydrogel contact lenses for daily wear (2000–2023): An update

PurposeIntroduced around the turn of the 21st century, silicone hydrogel contact lenses alleviated hypoxic anterior eye complications due to their high oxygen transmissibility. The purpose of this work is to update earlier surveys by describing international trends in silicone hydrogel daily wear contact lens fitting between 2000 and 2023. MethodAn annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 260,144 daily wear soft contact lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of silicone hydrogel daily wear contact lens fitting. ResultsThere has been a dramatic increase in silicone hydrogel daily wear lens fits (p < 0.0001), increasing from 2.8 % of all daily wear soft lens fits in 2000 to 73.7 % in 2023. Of all daily wear soft contact lenses prescribed to males, 44.6 % were silicone hydrogel lenses, compared with 43.5 % for females (p = 0.0146). The mean age of those wearing silicone hydrogel daily wear lenses was 32.0 ± 14.5 years, compared to 30.4 ± 13.6 years for those wearing daily wear hydrogel lenses (p < 0.0001). Between 2019–2023, the average percentage of fits was – (a) material type: silicone hydrogel – 73 %; mid-water content hydrogels – 13 %; high water content hydrogels – 9 %; and low water content hydrogels – 5 %, and (b) lens design: spherical – 44 %, toric – 32 %, multifocal – 17 %, monovision – 4 %, and ‘other’ – 3 %. ConclusionThe dramatic increase in silicone hydrogel contact lens prescribing for daily wear has been commensurate with the introduction of multiple lens brands and an ongoing expansion of lens designs, parameters and replacement frequency options. The balance between silicone hydrogel and hydrogel lens prescribing is perhaps starting to approach an equilibrium.

Anpassung von Skleral-Kontaktlinsen bei Terrien‘s marginaler Hornhautdegeneration

Purpose. This case report describes the possible visual rehabilitation with scleral lenses of a patient with Terrien’s marginal degeneration with different degrees of progression between the right and left eye. Material and Methods. Scleral contact lenses were fitted with the help of corneal tomography and by observing and assessing the fit of measuring lenses. A slit lamp with a corresponding camera helped to modify the diagnostic lenses. Results. In this case, the fitting of scleral contact lenses resulted in an improvement in distance vision in both the right and left eye. Near vision could not be evaluated at the time of writing. Conclusion. Scleral contact lenses can be a good alternative to glasses for complex corneas to improve visual performance. It is recommended to use a slit lamp with a camera to make it easier to discuss scleral contact lenses modifications with the manufacturer of the lenses. Keywords: TERRIEN’S MARGINAL CORNEAL DEGENERATION, PELLUCIDE MARGINAL CORNEAL DEGENERATION, SCLERAL LENSES

Kontaktlinsenversorgung bei ausgeprägter Sicca bei vermuteter Alakrimie bei einem sechsjährigen Kind

Purpose. The aim of this case report is to describe a case of suspected alacrimia in a six-year-old child that resulted in irregular astigmatism with risk of amblyopia. A specialty contact lens fitting for visual rehabilitation was performed. Material and Methods. Different wearing modes (extended wear and daily wear) as well as contact lens types (soft silicone hydrogel contact lenses of different wearing rhythms, as well as rigid gas permeable (RGP) contact lenses were fitted. Results. In this case, different contact lens types (soft and rigid contact lenses) could not achieve a satisfactory treatment result. However, a piggyback contact lens system with daily wear was a good treatment solution. Conclusion. Irregular astigmatism in children is always a high risk of amblyopia. For this reason, timely optical treatment for visual rehabilitation is a high priority. Sometimes it is necessary to combine different contact lenses and wearing modalities to achieve the best solution for a complex treatment situation. Keywords: ALACRIMIA, HYPOLACRIMIA, SICCA, IRREGULAR ASTIGMATISM, VISUAL REHABILITATION, AMBLYOPIA RISK

International trends in prescribing extended wear soft contact lenses (2000–2023): An update

PurposeExtended wear has long been considered as the ultimate contact lens modality in terms of user convenience. The purpose of this work is to update earlier surveys by describing international trends in extended wear soft lens fitting between 2000 and 2023, inclusive. MethodAn annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 282,142 soft contact lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of extended wear soft lens fitting. ResultsOver the duration of the work there was a very small decrease in the prescribing of extended wear soft lenses (p < 0.0001). More detailed inspection shows that prescribing of these lenses steadily increased from 5.8 % of all soft lens fits in 2000 to 11.6 % in 2007, then steadily decreased to 5.2 % in 2023. Of all soft contact lenses prescribed to males, 9.2 % were fitted for extended wear, compared with 6.7 % for females (p < 0.0001). The mean age of extended wear soft lens wearers at fitting was 34.7 ± 14.7 years, compared to 31.1. ± 14.10 years for daily soft lens wearers (p < 0.0001). Analysis of 1,948 recent extended wear soft lens fits (2019–2023, inclusive), in terms of material type, revealed that, on average, 86 % and 14 % of extended wear soft lenses were fitted using silicone hydrogel and hydrogel materials, respectively. ConclusionA modest increase in extended wear soft lens prescribing from 2000 to 2007 corresponded with the introduction of high oxygen transmissibility silicone hydrogel lenses. However, prescribing of this lens type declined thereafter, probably due to ongoing concerns over their increased rate of microbial keratitis, resulting in a prescribing rate in 2023 (5.2%) that was little different to that observed in 2000 (5.8%).

Orthokeratology with the trial lens fitting and software fitting

Orthokeratology with the trial lens fitting and software fitting

Is it possible to calculate the sagittal height for soft contact lens fitting? Validation of a theoretical calculator: Sagitador

Is it possible to calculate the sagittal height for soft contact lens fitting? Validation of a theoretical calculator: Sagitador

International trends in prescribing toric soft contact lenses to correct astigmatism (2000–2023): An update

PurposeThere have been significant advancements in toric soft contact lens design and manufacturing technology, and increased product availability, over the past half a century. The purpose of this work is to update earlier surveys by describing international trends in toric soft lens fitting between 2000 and 2023, inclusive. MethodAn annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 220,934 standard soft daily wear single vision lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of toric soft lens fitting. ResultsOverall, toric soft lens prescribing almost doubled over the time-course of this survey, from 24.4 % of standard soft daily wear single vision lens fits in 2000 to 46.2 % in 2023 (p < 0.0001). There were significant differences between countries in toric soft lens prescribing (p < 0.0001). Of all standard soft daily wear single vision contact lenses prescribed to males, 32.0 % were toric soft lenses, compared with 28.7 % for females (p < 0.0001). The mean age of toric soft lens wearers was 30.5 ± 12.5 years, compared to 27.9. ± 12.1 years for spherical soft lens wearers (p < 0.0001). Analysis of 13,582 recent toric soft lens fits (2019–2023, inclusive), in terms of material type and replacement frequency, revealed the following proportions: reusable silicone hydrogel – 51 %; daily disposable silicone hydrogel – 27 %; daily disposable hydrogel – 12 %; and reusable hydrogel – 10 %. ConclusionThere has been a substantial increase in toric soft lens fitting throughout the 24 years of this survey, to a point whereby almost all clinically significant astigmatism is being corrected among those wearing standard soft daily wear single vision lenses.

Development and evaluation of a deep neural network model for orthokeratology lens fitting.

To optimise the precision and efficacy of orthokeratology, this investigation evaluated a deep neural network (DNN) model for lens fitting. The objective was to refine the standardisation of fitting procedures and curtail subjective evaluations, thereby augmenting patient safety in the context of increasing global myopia. A retrospective study of successful orthokeratology treatment was conducted on 266 patients, with 449 eyes being analysed. A DNN model with an 80%-20% training-validation split predicted lens parameters (curvature, power and diameter) using corneal topography and refractive indices. The model featured two hidden layers for precision. The DNN model achieved mean absolute errors of 0.21 D for alignment curvature (AC), 0.19 D for target power (TP) and 0.02 mm for lens diameter (LD), with R2 values of 0.97, 0.95 and 0.91, respectively. Accuracy decreased for myopia of less than 1.00 D, astigmatism exceeding 2.00 D and corneal curvatures >45.00 D. Approximately, 2% of cases with unique physiological characteristics showed notable prediction variances. While exhibiting high accuracy, the DNN model's limitations in specifying myopia, cylinder power and corneal curvature cases highlight the need for algorithmic refinement and clinical validation in orthokeratology practice.

Optometrists’ perspectives on speciality programme development in South Africa

Background: South Africa (SA) has postgraduate research-based master’s and doctorate qualifications in optometry with no clinical coursework qualifications in special interest fields. As a result, it hinders professional growth and career path for optometrists and further limits patients’ access to various care pathways from would-be upskilled optometrists.Aim: To explore optometrists’ perspectives on postgraduate programme development in special interest fields of optometry for SA.Setting: Study population of practicing optometrists registered with the Health Professions Council of South Africa (HPCSA).Methods: A quantitative cross-sectional descriptive design was employed, utilising an online questionnaire developed with the Evasys survey system v8.2. Non-probability sampling was used to access eligible participants.Results: From 424 survey responses, 83.5% had undergraduate qualifications and 95.5% worked in patient-facing environments. Participants responded positively (88%) to this need for educational expansion. Educational needs in Ocular Disease (75.6%), Paediatric Optometry (66.4%), Binocular Vision (65.1%) and sub-specialties of myopia control (41.2%) and Specialised Contact Lens Fitting (31%) were reported. With combined ‘highly important’ and ‘likely important’ responses, participants indicated that obtaining professional recognition (94.9%) and to improve patient care (98.8%) were the main drivers for pursuing additional education and training.Conclusion: A notable demand was found for coursework postgraduate programmes by the study populations from which professional recognition can be awarded in various special interest fields of optometry. The benefit of improved patient care from upskilled optometrists was expressed.Contribution: The findings would contribute towards the development of a conceptual framework for postgraduate education and training for optometrists in SA.

CONTACT LENSES: Introduction to scleral contact lenses

Contact lens expert, Nick Howard, outlines the fascinating history of scleral contact lens fitting

Bacterial contamination in contact lens training area in private optical clinics

BackgroundContamination in the contact lens training area could be due to bacteria, which can lead to the major consequence of ocular infections. We aimed to investigate the contamination caused by bacteria in the contact lens training area in private optical clinics of the Udupi district, India.MethodsA cross-sectional study evaluated the swabs from the contact lens container, contact lens solution tip, washing area and lens fitting area for bacterial contamination. Twenty swabs collected from different areas of five optical clinics were inoculated in Brain heart infusion broth (BHIB). The broth was streaked in MacConkey and Blood agar and incubated at standard conditions for the growth of bacteria. All isolates were identified using conventional culture methods, and Gram staining was performed.ResultsTwenty samples (contact lens case, n = 5; contact lens solution tip, n = 5; washing area, n = 5; cleaning towel, n = 5) from private optical clinics were recruited for the study. Bacterial growth was indicated in which lactose fermentation was seen at (15%), non-lactose fermentation at (35%), and no bacterial growth at (50%) in MacConkey agar. Partial or alpha-hemolytic (α hemolysis) was seen in (5%), complete or beta-hemolytic (β hemolysis) was seen in (40%), no hemolysis or gamma hemolysis (ϫ haemolysis), was seen in (30%), no growth was seen in (25%) on blood agar. Gram-positive cocci (45%), Gram-negative bacilli (20%), and no increase in (35%) were observed in MacConkey agar and Blood agar. Bacterial species were not identified in this study.ConclusionContamination was found in lenses, solution tips, washing areas, and cleaning towels which might lead to ocular infections. Perception should be given to those responsible for fitting lenses.

International trends in daily disposable contact lens prescribing (2000–2023): An update

PurposeDaily disposable contact lenses offer numerous benefits in terms of ocular health and wearer convenience. The purpose of this work is to update earlier surveys by describing global trends in daily disposable lens fitting between 2000 and 2023. MethodAn annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 265,106 daily wear soft lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of daily disposable lens fitting. ResultsOverall, daily disposable lens prescribing increased over time, from 17.1 % of daily wear soft lens fits in 2000 to 46.7 % in 2023 (p < 0.0001). There were significant differences between countries in daily disposable lens prescribing (p < 0.0001), and between the percentage of males fitted with daily disposable lenses, as a proportion of all daily wear soft lenses (37.2 %), compared to females (35.2 %) (p < 0.0001). Daily disposable lens wearers are slightly younger at fitting than reusable soft lens wearers (31.0 vs 31.2 years, respectively) (p < 0.0001), although this difference is not clinically meaningful. Analysis of 50,240 daily wear soft lenses fitted recently (2019–2023) were found to be prescribed for the following replacement frequencies: daily – 47 %; monthly – 42 %; 1–2 weekly – 9 %; and ≥3 monthly – 2 %. ConclusionThere has been a substantial increase in daily disposable lens fitting throughout the first 24 years of this century. The gradual nature of this increase is commensurate with the staged introduction of daily disposable lens designs and expanded parameter ranges over the survey period.

International trends in rigid contact lens prescribing (2000–2023): An update

PurposeRigid contact lenses have an important role in contact lens practice. The purpose of this work is to update earlier surveys by describing global trends in rigid lens fitting between 2000-2023. MethodAn annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023. Data relating to 342,500 fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of rigid lens fitting, defined as the fitting of any design of a contact lens manufactured in a rigid material. ResultsOverall, rigid lens prescribing increased slightly over time, from 14.2 % of lens fits in 2000 to 15.2 % in 2023 (p < 0.0001). However, post-hoc analysis shows that the change over time is best described as a decline between 2000 and 2012, followed by a steady increase subsequently. There were significant differences in rigid lens prescribing between countries (p < 0.0001). The difference between the percentage of males fitted with rigid lenses, as a proportion of all contact lenses (12.7 %), and females (12.0 %) is significant (p < 0.0001), although not clinically meaningful. Rigid lens wearers are older at fitting than soft lens wearers (38.7 vs 31.3 years, respectively) (p < 0.0001). Analysis of 5,994 rigid lens fits prescribed currently (2019–2023) were categorised as: corneal sphere – 30 %; scleral and corneo-scleral – 28 %; corneal myopia control/orthokeratology – 21 %; and corneal complex (including toric, multifocal and monovision) – 16 %. ConclusionThere has been a slight increase in rigid lens fitting during the second decade of this century. This increase is apparently due to a ‘repurposing’ of rigid lenses, with the growth of scleral/corneo-scleral and myopia control/orthokeratology lens fits essentially replacing conventional spherical corneal lens fits.

BCLA CLEAR Presbyopia: Management with corneal techniques

Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye’s depth of focus [1]. This report reviews the evidence for the treatment profile, safety, and efficacy of the current range of corneal techniques for managing presbyopia.The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations.Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. In presbyopia correction by conductive keratoplasty, radiofrequency energy is applied to the mid-peripheral corneal stroma, leading to mid-peripheral corneal shrinkage and central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia.Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.