Surgical correction of presbyopia continues to be one of the biggest challenges for refractive surgeons. We have read with great interest the article by Baudu and associates about the postoperative binocular visual results of LASIK using PresbyMAX, a corneal multifocal ablation profile for the treatment of presbyopia.

Baudu and associates state in their article that the majority of patients treated with PresbyMAX achieve an acceptable uncorrected near visual acuity of p3 or better, although more than a 25% of patients obtained an uncorrected distance visual acuity two or more lines lower than the preoperative corrected distance visual acuity. Furthermore, although the optical results obtained by PresbyMAX seemed to be predictable, 17% of patients did not obtain objective successful outcomes, and thus, the retreatment rate was quite high—20%.

In addition, one of the major concerns about multifocality is the reversibility of the procedure; in other words, how easy it is to get a monofocal cornea in certain unsatisfied patients with surgically induced multifocal corneas. We think that it would have been very interesting to know the visual results after PresbyMAX enhancement (not provided in the article), both in the patients who had residual refraction (with the target of achieving emmetropia and keeping the multifocal profile) and in the patients intolerant to multifocality and wishing to have monofocal corneas again.

On the other hand, the authors compare the visual results of PresbyMAX with the results of a very small cohort (only 17 patients) treated with monovision. Although the sample size was quite different in both groups, it is remarkable that monovision patients obtained similar or even better visual results than the patients treated using PresbyMAX. In fact, we have previously published our results about the visual performance of LASIK-induced monovision, and we proved a couple of facts that, we think, are noteworthy. First, patients with LASIK-induced monovision achieve good binocular uncorrected near visual acuity, and they are able to read without spectacles at a normal reading distance while maintaining good binocular uncorrected distance visual acuity. Second, monovision has the important advantage of being an easily reversible procedure. In fact, and in contrast to the multifocal procedures, it is easy for a patient with LASIK-induced monovision to improve the distance or near visual acuity for certain tasks, such as night driving in the rain, reading fine print and wearing glasses. In this case, the quality of the “corrected vision with spectacles” should be almost perfect because it is monofocal in both eyes.

For these reasons, we believe that further investigation is needed to improve our knowledge about the real advantages and disadvantages of the various procedures currently available for the treatment of presbyopia, including their reversibility.