Dr Francisco J. Abellán
Presbyopia in Madrid: intraocular lens, phakic lens or monovision
Assessment of the crystalline lens, prescription and working distances to decide whether presbyopia surgery is appropriate and, if so, which strategy may fit.
Ophthalmologist · Medical registration no. 282880215
Trained at Hospital Universitario de La Princesa
- 1Age and crystalline lens
- 2Prescription
- 3Cornea and ocular surface
The practice secretary manages administrative information and private appointments.
Questions the assessment answers
Presbyopia affects everyone with age; treating it surgically is an individual decision made after the assessment.
Is the crystalline lens healthy, or is a cataract starting?
Is it better to keep the natural lens or replace it?
Which distances matter most: far, computer or reading?
Would monovision be tolerated?
Candidacy assessment
Surgery may be postponed or ruled out when findings are unfavourable.
Age and crystalline lens
Lens clarity and signs of early cataract.
Prescription
Associated myopia, hyperopia or astigmatism and its stability.
Cornea and ocular surface
Corneal shape, tear film and dryness, which influence quality of vision.
Pupil and macula
These determine whether a multifocal lens is suitable.
Anterior chamber and endothelium
These determine whether a phakic lens is possible.
Activities
Night driving, screens, reading and tolerance of halos.
Which distances stay clear with each option
An illustrative simulation: it does not predict your result, which depends on the assessment of your eye.
Functional: small print may need glasses
Tap far, intermediate or near to zoom in, then switch option to compare.
Simulate vision with:
Uncorrected presbyopia
Typical vision with presbyopia when there was no distance prescription: distance vision is preserved, intermediate is acceptable and reading up close means holding text further away or using glasses. It is a natural age-related change in the crystalline lens, not a disease.
Uncorrected presbyopia: far, Clear; intermediate, Functional; near, Glasses.
Options for presbyopia
No option is best for everyone; each involves different trade-offs.
Intraocular lens (lens replacement)
The crystalline lens is replaced with a trifocal, extended-depth-of-focus or monofocal lens. It is usually considered from about 50–55 or with early cataract; it is intraocular surgery with its own risks.
Presbyopia-correcting phakic lens
An extended-depth-of-focus lens implanted without removing the natural lens. It may be considered in younger patients with a prescription and suitable anatomy.
Monovision
One eye for distance and the other for near, with an intraocular or phakic lens. It is trialled first with contact lenses.
No surgery
Varifocal or reading glasses, multifocal contact lenses or waiting remain valid options.
Types of intraocular lens
Monofocal, extended depth of focus and trifocal: what each lens offers and the trade-offs involved.
Frequently asked questions about presbyopia
What is presbyopia and when does it start?
It is the gradual loss of near focusing because the crystalline lens becomes less flexible. It is usually noticed from about 40–45 and tends to stabilise around 60. It is a natural change, not a disease.
Intraocular lens or phakic lens?
It depends mainly on age and the condition of the crystalline lens. If the lens is starting to lose clarity, replacing it with an intraocular lens is usually considered; if it is healthy and there is a prescription to correct, a phakic lens that preserves it may be assessed. Only the examination allows a choice.
What is monovision and how is it tested?
One eye is focused for distance and the other for near. Before surgery it is trialled for a few days with contact lenses to check whether the brain adapts and depth perception remains adequate.
Will I be completely free from glasses?
Dependence on glasses can be reduced substantially, but it cannot be guaranteed. The result depends on the eye, the option chosen, adaptation and changes with age; some tasks may still require glasses.
Authorship, medical review and sources
- Author and medical reviewer
- Dr. Francisco Javier Abellán Martínez
- Ophthalmologist · Medical registration no. 282880215
- The same specialist currently authors and medically reviews the content; this is not presented as an independent external review.
- Last medically reviewed
Sources consulted (6)
- ESCRS recommendations for cataract surgery (Opens in a new tab)European Society of Cataract and Refractive Surgeons (ESCRS)
- Cataracts in adults: management (NG77) (Opens in a new tab)National Institute for Health and Care Excellence (NICE)
- Cataract surgery: procedure and recovery (Opens in a new tab)National Health Service (NHS)
- Patient information booklets (Opens in a new tab)The Royal College of Ophthalmologists
- Refractive surgery patient information (Opens in a new tab)The Royal College of Ophthalmologists
- Refractive surgery standards and guidance (Opens in a new tab)The Royal College of Ophthalmologists
General educational content. It does not replace an individual assessment, diagnosis or personalised instructions from your healthcare team.
How these guides are written and reviewedPresbyopia assessment in Madrid
Private consultation at Centro de Especialidades Clara del Rey, Hospital Quirónsalud San José. The first decision is whether surgery is advisable; the strategy is chosen after the examination.
WhatsApp is an administrative channel. It does not replace a consultation, cannot manage emergencies and should not be used to send sensitive clinical information.
Before the assessment
If you wear contact lenses, you may need to stop wearing them a few days beforehand: they change the shape of the cornea and the measurements. The secretary will tell you how many days. Your pupils may also be dilated, so come accompanied and do not drive afterwards.
How to prepare for your appointment