PresbyMAX is generally not suitable in keratoconus, because further corneal reshaping can worsen irregularity and stability.
Risks in keratoconic corneas
Laser may aggravate disease.
- Thinning and irregular shape already compromise biomechanical strength
- Additional ablation can trigger progression or ectasia
- Irregular astigmatism reduces the predictability of multifocal profiles
- Quality of vision may deteriorate despite intended presbyopia correction
- Standard refractive guidance lists keratoconus as a contraindication
Safer approaches for presbyopic keratoconus
Alternative strategies are preferred.
- Maximising vision with rigid or scleral contact lenses
- Corneal cross‑linking to stabilise shape, where appropriate
- Lens‑based procedures if internal optics are the main limitation
- Use of reading glasses or multifocal contacts for near tasks
- Management in a specialist cornea and refractive clinic
