An interview with Professor Reinstein on PRESBYOND® Laser Blended Vision and ReLEx SMILE

Dan Reinstein

What is PRESBYOND® Laser Blended Vision?

PRESBYOND® Laser Blended Vision is a sophisticated laser eye surgery treatment to get around the effects of ageing of the eye (presbyopia), which was devised by myself, here at the London Vision Clinic in 2004 and implemented by Carl Zeiss into their laser platform as PRESBYOND® in 2009.

PRESBYOND® Laser Blended Vision is modified binocular vision (vision using both eyes with an overlapping field of vision) and we intentionally correct the eyes slightly differently. The dominant eye is focused to see mainly distance to intermediate vision (computer-viewing distance), while the other eye is focused to be clearest up close at a normal reading distance with continuous focus into intermediate where it overlaps or ‘blends’ with the intermediate vision of the other eye.

This means that with both eyes open, which is our normal state, you experience a continuum of good vision from a normal near working distance, through intermediate distances, all the way to far distance. PRESBYOND® Laser Blended Vision is performed as a LASIK, Keyhole LASIK (SMILE) or PRK procedure in the same way, the difference is it is designed to address both your distance vision and near vision together.

What are the advantages of PRESBYOND® Laser Blended Vision over traditional monovision?

PRESBYOND® Laser Blended Vision mustn’t be confused with traditional monovision which is when one eye is set for distance and one eye for near. PRESBYOND® Laser Blended Vision is a modification of binocular vision which is achieved by increasing the depth of field so that one eye does somewhat more work at distance and the other more at near, which both eyes working together at all times.

PRESBYOND® Laser Blended Vision therefore holds a number of advantages. With an increased depth of field, patients will benefit from improved distance and immediate vision, and as a result of the ‘blend’ zone, patients are also more likely to tolerate this technique over monovision.

On a patient with presbyopia, do you prefer to perform PRESBYOND® Laser Blended Vision or a Clear Lens Exchange with a multifocal implant?

In our clinic, when the patient has a clear lens, we would always choose to perform PRESBYOND® Laser Blended Vision over Clear Lens Exchange. Although there are arguments to support removing the natural lens inside the eye as a preventative method for cataract formation, these are still outweighed by the safer, less invasive, and more accurate PRESBYOND® Laser Blended Vision procedure. There are also fewer side effects reported following PRESBYOND® Laser Blended Vision than multifocal IOLs.

What do you think are the main advantages of SMILE over LASIK or PRK?

Each procedure may offer benefits, but we evaluate this on a patient by patient basis rather than to generalise as a whole. In our clinic, all three procedures are charged at the same fee and are spoken about on an equal level when discussing options with a patient. However, as mentioned before, there will always be a reason for me to choose one procedure over another for any particular patient; I do not offer “options” and allow the patient to choose the procedure. It’s all or nothing with only the best option on the table.

At London Vision Clinic, approximately 1% of patient cases with refractive error are performed as PRK. While PRK is a very safe and effective procedure it is most often reserved for patients who are not candidates for other laser treatments. PRK is not a ‘cheaper option’ in our practice, it is charged at the same fee as SMILE and LASIK.

Seen as the ‘latest technology’ procedure, what do you think about SMILE?

The reality is that, even in SMILE’s relative infancy compared to LASIK, the results are impressive. SMILE means that clinics are now able to offer procedure best suits their patients adds another tool for refractive surgeons to use to help best serve their patients. With over 1.5 million procedures performed to date, this is proving a great option for many patients.

In fact, we have written a textbook on SMILE which was released in April 2018 which has many chapters dedicated to educating Surgeons on the procedure and busting any myths out there.

In addition of being an extraordinary surgeon you are a great music musician. How was this love of music born?

I started playing piano when I was 4 years old in the Yamaha School of Music in Mexico City and went on to the Conservatorio Nacional de Musica when I was 8. When I started boarding school in London, at the age of 14, I switched to saxophone and never looked back.

When deciding on whether music or medicine would be my career, I decided that if I were to be able to do both, I’d have to study medicine. I was very fortunate that my medical school tutors at Cambridge and London were open to my request to take a sabbatical year in the middle of medical school to go study at the Berklee College of Music in Boston – at that time, the top jazz school in the world. I returned for another year of medical school and, amazingly, was given permission to return to Berklee for another year to complete a Two Year Certificate.

Those years at Berklee were incredibly challenging: I practiced 5 to 6 hours a day as well as attended jazz theory, arranging and composition classes. It was music 18 hours a day, but it did the job… I am now able to play well enough to keep up with the top jazz musicians that I play with regularly at the 606 Club in Chelsea despite having a busy surgical practice. I feel very lucky to have been able to keep both passions going in parallel.