PRESBYOND is generally not suitable when corneal topography is abnormal, especially if there are signs of ectasia or significant irregularity.
Why abnormal topography is a red flag
It signals higher risk and unpredictability.
- May indicate early keratoconus or biomechanical weakness
- Further ablation can destabilise the cornea and worsen shape
- Blended‑vision profiles rely on a regular surface for good quality optics
- Risk of glare, ghosting, and reduced contrast increases
- Standard refractive guidelines treat suspicious topography as a contraindication
Alternative management
Other strategies are preferred.
- Specialty contact lenses to optimise optics
- Cross‑linking where progressive ectasia is present
- Lens‑based presbyopia solutions in appropriate cases
- Use of reading or multifocal glasses for near tasks
- Close follow‑up by a corneal specialist instead of corneal laser
