Refractive Surgery in São Paulo

Presbyopia is the age-related loss of near focusing ability, usually noticed after the early 40s. It is different from myopia, hyperopia or astigmatism: the natural lens gradually loses flexibility, so reading and phone distance become harder even when distance vision is good.

Some presbyopic patients can be considered for corneal laser strategies that increase depth of focus, often combined with a small intentional difference between the two eyes. These approaches try to reduce dependence on reading glasses, but they involve visual trade-offs and require careful simulation and counseling.

PRESBYOND Laser Blended Vision is a ZEISS software-based LASIK strategy for presbyopia, planned around binocular vision, micro-anisometropia and customized depth of focus.

READ (Refractive-Enhanced Aspheric Design) is the approach described by Dr. Damien Gatinel for selected presbyopic hyperopic and emmetropic patients. It is implemented in the Alcon WaveLight EX500 excimer laser software; when performed as FemtoLASIK, the corneal flap can be created with the WaveLight FS200 femtosecond laser.

Neither option is a universal fix for presbyopia. Patient age, dominant eye, distance prescription, pupil size, ocular surface, lens status, night-driving needs and tolerance for blended vision all change the recommendation.

Laser refractive surgery reshapes the cornea with micrometric precision so that light focuses more accurately on the retina. The goal is to reduce, and in many cases eliminate, dependence on glasses or contact lenses for daily life.

The most common procedures are LASIK, FemtoLASIK, PRK and SMILE. For patients with high myopia, thin corneas or anatomy that makes laser surgery less suitable, phakic intraocular lenses may be a better option.

The surgery is usually performed with anesthetic eye drops, without hospitalization. The procedure itself is short, but the decision is never casual: the quality of the preoperative evaluation is what determines whether surgery is safe and which technique makes sense.

A typical candidate is over 18, has a stable prescription for at least one year, healthy eyes, adequate corneal thickness and curvature, and realistic expectations. Borderline cases require careful individualized analysis.

Patients with signs of keratoconus, unstable refraction, active ocular surface disease, uncontrolled dry eye, certain autoimmune diseases or high-risk retinal findings may need treatment first, a different surgical plan, or a recommendation not to operate.

For patients over 40, near vision must be discussed separately. Conventional laser correction does not stop presbyopia, so reading glasses, monovision, blended-vision strategies or lens-based options may be considered depending on the case.

The preoperative workup evaluates the cornea, retina, optic nerve, tear film, prescription stability and medical history. When possible, complementary exams are performed in the same appointment.

• Corneal topography and tomography to study shape, thickness and keratoconus risk.
• Refraction and visual acuity testing to confirm the prescription and visual potential.
• Dry-eye and ocular surface evaluation, because untreated dry eye can affect comfort and results.
• Retinal mapping and optic nerve evaluation to identify findings that may change the surgical plan.
• Lifestyle and occupational review, including sports, screen work, travel timeline and visual goals.

This screening is especially important for international patients, because the safest plan may require a staged approach, additional testing, or postponing surgery until the ocular surface is optimized.

LASIK / FemtoLASIK: a thin corneal flap is created, the excimer laser corrects the prescription underneath, and the flap is repositioned. Visual recovery is usually fast.

PRK: the surface epithelium is removed and the excimer laser treats the cornea without creating a flap. PRK can be useful for selected patients with thinner corneas or higher trauma exposure.

SMILE: a femtosecond laser creates a small lenticule inside the cornea, which is removed through a small incision. It may be discussed in selected myopia cases.

Phakic IOL / ICL: an implantable lens is placed inside the eye while the natural crystalline lens remains in place. It is often considered for high myopia or patients who are not ideal laser candidates. Learn more on our phakic IOL page.

Recovery varies by technique. LASIK and SMILE often have faster early visual recovery, while PRK usually has more discomfort and slower stabilization during the first days. Most patients need several postoperative visits.

• Use all prescribed eye drops exactly as instructed.
• Avoid rubbing the eyes, swimming pools and seawater during the early healing period.
• Plan follow-up before returning home, especially if you are travelling internationally.
• Report severe pain, marked redness or sudden vision loss urgently.

International patients should discuss the full timeline before scheduling surgery. The safest plan is to allow enough time in São Paulo for preoperative testing, the procedure and early postoperative checks.

Refractive surgery has a long track record and high patient satisfaction when well indicated, but it is still surgery. A serious consultation includes risks, limitations and alternatives.

• Residual prescription may require glasses, contact lenses or a later enhancement in selected cases.
• Dry eye is common in the first months and is usually temporary, but some patients need longer treatment.
• Infection or inflammation is uncommon but must be treated quickly if warning symptoms appear.
• Corneal haze or ectasia are rare but important risks, especially when screening is inadequate.
• Presbyopia still progresses with age and may affect near vision after age 40.

The purpose of the evaluation is not to convince every patient to have surgery. It is to decide whether surgery is appropriate, which procedure is safest, and when another option is more responsible.