PresbyMAX is usually unsuitable in significantly irregular corneas, because multifocal laser patterns rely on a regular corneal surface.
Why irregularity is a problem
Outcomes become unpredictable.
- Irregular astigmatism reduces the quality of post‑operative optics
- Risk of worsening higher‑order aberrations and ghosting
- Irregularity may signal early ectasia, which laser can aggravate
- Achieving a balanced multifocal profile is technically difficult
- Visual complaints may increase rather than decrease after surgery
Alternative management
Other tools address irregular corneas better.
- Rigid, scleral, or hybrid contact lenses to regularise optics
- Topography‑guided laser in strictly selected stabilised cases (not necessarily PresbyMAX)
- Lens‑based solutions combined with specialised contact lenses
- Ongoing monitoring for progression or need for cross‑linking
- Individualised plan from a corneal specialist
