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Progress in Retinal and Eye Research Jan 2019Presbyopia is a global problem affecting over a billion people worldwide. The prevalence of unmanaged presbyopia is as high as 50% of those over 50 years of age in... (Review)
Review
Presbyopia is a global problem affecting over a billion people worldwide. The prevalence of unmanaged presbyopia is as high as 50% of those over 50 years of age in developing world populations, due to a lack of awareness and accessibility to affordable treatment, and is even as high as 34% in developed countries. Definitions of presbyopia are inconsistent and varied, so we propose a redefinition that states "presbyopia occurs when the physiologically normal age-related reduction in the eye's focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual's requirements". Strategies for correcting presbyopia include separate optical devices located in front of the visual system (reading glasses) or a change in the direction of gaze to view through optical zones of different optical powers (bifocal, trifocal or progressive addition spectacle lenses), monovision (with contact lenses, intraocular lenses, laser refractive surgery and corneal collagen shrinkage), simultaneous images (with contact lenses, intraocular lenses and corneal inlays), pinhole depth of focus expansion (with intraocular lenses, corneal inlays and pharmaceuticals), crystalline lens softening (with lasers or pharmaceuticals) or restored dynamics (with 'accommodating' intraocular lenses, scleral expansion techniques and ciliary muscle electrostimulation); these strategies may be applied differently to the two eyes to optimise the range of clear focus for an individual's task requirements and minimise adverse visual effects. However, none fully overcome presbyopia in all patients. While the restoration of natural accommodation or an equivalent remains elusive, guidance is given on presbyopic correction evaluation techniques.
Topics: Accommodation, Ocular; Aging; Ciliary Body; Contact Lenses; Eyeglasses; Humans; Laser Therapy; Lens, Crystalline; Lenses, Intraocular; Presbyopia; Refractive Surgical Procedures; Visual Acuity
PubMed: 30244049
DOI: 10.1016/j.preteyeres.2018.09.004 -
Asia-Pacific Journal of Ophthalmology... 2020Presbyopia reduces an individual's ability to perform visual tasks at near distances. It is a global problem, affecting over a billion people worldwide. Contact lenses,... (Review)
Review
Presbyopia reduces an individual's ability to perform visual tasks at near distances. It is a global problem, affecting over a billion people worldwide. Contact lenses, glasses, refractive surgery, and intraocular lens surgery are the main modalities in presbyopia treatment, although they all have some disadvantages. Thus, there is an increasing need for effective, easy-to-use, and noninvasive approaches for treating presbyopia while not limiting patients' daily activities. Pharmacological presbyopia treatment as an alternative method has been under investigation in recent years. We reviewed all relevant articles using the keywords "presbyopia," "presbyopia treatment," "pharmacological presbyopia treatment," and "presbyopic corrections" from 2010 to February 9, 2020, and summarized the main results of clinical trials, investigating the drops used for presbyopia treatment.
Topics: Accommodation, Ocular; Cyclooxygenase 2 Inhibitors; Drug Therapy, Combination; Humans; Muscarinic Agonists; Ophthalmic Solutions; Presbyopia; Refraction, Ocular; Treatment Outcome
PubMed: 32511122
DOI: 10.1097/APO.0000000000000297 -
Ophthalmology Oct 2018Presbyopia prevalence and spectacle-correction coverage were estimated by systematic review and meta-analysis of epidemiologic evidence, then modeled to expand to... (Meta-Analysis)
Meta-Analysis
TOPIC
Presbyopia prevalence and spectacle-correction coverage were estimated by systematic review and meta-analysis of epidemiologic evidence, then modeled to expand to country, region, and global estimates.
CLINICAL RELEVANCE
Understanding presbyopia epidemiologic factors and correction coverage is critical to overcoming the burden of vision impairment (VI) from uncorrected presbyopia.
METHODS
We performed systematic reviews of presbyopia prevalence and spectacle-correction coverage. Accepted presbyopia prevalence data were gathered into 5-year age groups from 0 to 90 years or older and meta-analyzed within World Health Organization global burden of disease regions. We developed a model based on amplitude of accommodation adjusted for myopia rates to match the regionally meta-analyzed presbyopia prevalence. Presbyopia spectacle-correction coverage was analyzed against country-level variables from the year of data collection; variation in correction coverage was described best by a model based on the Human Development Index, Gini coefficient, and health expenditure, with adjustments for age and urbanization. We used the models to estimate presbyopia prevalence and spectacle-correction coverage in each age group in urban and rural areas of every country in the world, and combined with population data to estimate the number of people with near VI.
RESULTS
We estimate there were 1.8 billion people (prevalence, 25%; 95% confidence interval [CI], 1.7-2.0 billion [23%-27%]) globally with presbyopia in 2015, 826 million (95% CI, 686-960 million) of whom had near VI because they had no, or inadequate, vision correction. Global unmet need for presbyopia correction in 2015 is estimated to be 45% (95% CI, 41%-49%). People with presbyopia are more likely to have adequate optical correction if they live in an urban area of a more developed country with higher health expenditure and lower inequality.
CONCLUSIONS
There is a significant burden of VI from uncorrected presbyopia, with the greatest burden in rural areas of low-resource countries.
Topics: Eyeglasses; Global Health; Humans; Presbyopia; Prevalence; Vision Disorders; Visual Acuity; Visually Impaired Persons
PubMed: 29753495
DOI: 10.1016/j.ophtha.2018.04.013 -
JAMA Ophthalmology Apr 2022AGN-190584 (Allergan, an AbbVie company) is an optimized topical formulation of pilocarpine hydrochloride, 1.25%, designed for managing presbyopia and enhanced with a... (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
AGN-190584 (Allergan, an AbbVie company) is an optimized topical formulation of pilocarpine hydrochloride, 1.25%, designed for managing presbyopia and enhanced with a proprietary vehicle.
OBJECTIVE
To evaluate the efficacy and safety of pilocarpine hydrochloride, 1.25%, in individuals with presbyopia.
DESIGN, SETTING, AND PARTICIPANTS
This vehicle-controlled, participant- and investigator-masked, randomized, phase 3 clinical study, GEMINI 1, enrolled individuals with presbyopia, aged 40 to 55 years, at 36 sites in the United States from December 21, 2018, to October 31, 2019. Analysis took place between February 2020 and December 2021.
INTERVENTIONS
AGN-190584 or the AGN-190584 formulation vehicle was administered bilaterally, once daily for 30 days.
MAIN OUTCOMES AND MEASURES
The proportion of participants with improvement of 3 or more lines in mesopic, high-contrast, binocular distance-corrected near visual acuity (DCNVA) at hours 3 and 6 on day 30 were the primary and key secondary efficacy end points, respectively. Safety measures included adverse events.
RESULTS
Of 323 participants who were randomized, 235 (72.8%) were female and 292 (90.4%) were White. The mean (SD) age was 49.6 (3.5) years, and the baseline mean (SD) mesopic DCNVA was 29.2 (6.3) letters. A total of 163 individuals were randomized to AGN-190584 and 160 were randomized to vehicle. GEMINI 1 met its primary and key secondary efficacy end points. On day 30, hour 3, the percentage of participants with improvement of 3 or more lines in mesopic DCNVA was 30.7% (50 of 163) in the AGN-190584 group and 8.1% (13 of 160) in the vehicle group (difference, 22.5% [95% CI, 14.3%-30.8%]; adjusted P < .001). At hour 6, those percentages were 18.4% (30 of 163) and 8.8% (14 of 160), respectively (difference, 9.7% [95% CI, 2.3%-17.0%]; adjusted P = .01). At hour 8, the between-group difference in 3 or more lines of mesopic DCNVA gains was not statistically significant, but clinically relevant prespecified outcome measures demonstrated AGN-190584 superiority to vehicle in least-squares mean (SE) mesopic DCNVA change from baseline at hour 8 (5.4 [0.51] vs 3.6 [0.52] letters; P = .009) and photopic distance-corrected intermediate visual acuity at hour 8 (3.9 [0.44] vs 2.4 [0.45] letters; P = .01) and hour 10 (3.5 [0.46] vs 1.7 [0.47] letters; P = .004). No participants with mesopic DCNVA improvement of 3 or more lines at hour 3 had losses of more than 5 letters in mesopic, high-contrast, binocular-corrected distance visual acuity. The onset of effect was at 15 minutes. AGN-190584 demonstrated an acceptable safety and tolerability profile.
CONCLUSIONS AND RELEVANCE
AGN-190584 demonstrated superiority over vehicle in mesopic DCNVA on day 30, hours 3 and 6, with an acceptable safety profile. AGN-190584 is a safe and efficacious topical therapy for presbyopia through 30 days.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT03804268.
Topics: Color Vision; Female; Humans; Male; Pilocarpine; Presbyopia; Treatment Outcome; Visual Acuity
PubMed: 35238902
DOI: 10.1001/jamaophthalmol.2022.0059 -
Experimental Eye Research Apr 2021Presbyopia is a growing problem in view of an aging global population and increasingly patients desire spectacle-free solutions to address this condition. Surgically... (Review)
Review
Presbyopia is a growing problem in view of an aging global population and increasingly patients desire spectacle-free solutions to address this condition. Surgically implanted corneal inlays have been the topic of renewed research efforts in the past several years as a treatment option for presbyopia, with several approaches being used to modify the refractive properties of the cornea and enhance near vision. In this review we discuss historical approaches to corneal inlay surgery, critically appraise the current generation of presbyopia-correcting corneal inlays and their associated complications and consider the future prospects for emerging corneal inlay technologies that aim address the shortcomings of currently available inlays.
Topics: Aging; Corneal Stroma; Humans; Presbyopia; Prostheses and Implants; Prosthesis Implantation; Refraction, Ocular; Visual Acuity
PubMed: 33524364
DOI: 10.1016/j.exer.2021.108474 -
Journal of Refractive Surgery... Jun 2021Presbyopia affects 1.8 billion people worldwide. This reduction in distance corrected near visual acuity impacts quality of life, which prompts patients to seek... (Review)
Review
Presbyopia affects 1.8 billion people worldwide. This reduction in distance corrected near visual acuity impacts quality of life, which prompts patients to seek treatment. Presbyopia is an early manifestation of the "crystalline lens optical dysfunction through aging," or dysfunctional lens syndrome, and appropriate management of presbyopia is dependent on coexisting factors such as increased higher order aberrations, reduced contrast sensitivity, light scatter, and lenticular opacification. This review of published literature (PubMed and MEDLINE) is presented in narrative format and discusses medical and surgical treatments available to patients who experience presbyopia, while highlighting future therapies. Numerous strategies exist for the management of presbyopia. These strategies include pharmacological therapy, glasses and contact lenses, corneal, scleral, and lenticular procedures. This article discusses the role of several new and existing presbyopia treatments, as well as which patients are candidates for these novel therapies. Although no single treatment is ideal for all patients with presbyopia, new medical and surgical strategies increase the number of options available when addressing different stages of presbyopia and dysfunctional lens syndrome. .
Topics: Contrast Sensitivity; Eyeglasses; Humans; Presbyopia; Quality of Life; Visual Acuity
PubMed: 34170762
DOI: 10.3928/1081597X-20210408-06 -
Ugeskrift For Laeger Jan 2019Presbyopia, i.e. the loss of accommodative amplitude with age, results from increasing stiffness and thickness of the lens and leads to inability of the lens to change... (Review)
Review
Presbyopia, i.e. the loss of accommodative amplitude with age, results from increasing stiffness and thickness of the lens and leads to inability of the lens to change shape, refractive power and focus of the eye in response to the contraction of the ciliary muscle inside the eye. Multiple remedies are available, the most common being reading glasses. Alternative options include a monovision combination of monofocal lenses or the use of multifocal lenses, in the form of contact lenses or intraocular implant lenses, corneal implants or corneal refractive surgery. This review provides an update on current options and their limitations.
Topics: Cornea; Eyeglasses; Humans; Lenses, Intraocular; Presbyopia; Visual Acuity
PubMed: 30722817
DOI: No ID Found -
Ophthalmic & Physiological Optics : the... Jan 2019
Topics: Accommodation, Ocular; Adult; Contact Lenses; Equipment Design; Eyeglasses; Female; Humans; Male; Middle Aged; Presbyopia; Refraction, Ocular
PubMed: 30628739
DOI: 10.1111/opo.12594 -
Harefuah Jul 2022Presbyopia is the physiological, gradual, progressive loss of the ability to see clearly at near point which affects people as they age. It is primarily caused by the... (Review)
Review
Presbyopia is the physiological, gradual, progressive loss of the ability to see clearly at near point which affects people as they age. It is primarily caused by the thickening and stiffening of the lens leading to an inability to adjust its shape to become convex enough to induce adequate plus power to see at short distances. Symptoms usually begin affecting individuals around 40 years of age, the most common being discomfort in or around the eyes after prolonged near work, blur at distance after near work, and eventually progressing to near blur, often with a natural tendency to distance the object by holding it farther away to try to see it better. At a certain point near tasks become impossible and the patient will seek an external solution. Various therapies are available and being developed to treat presbyopia, which include glasses, contact lenses, intraocular lens implants, corneal laser procedures, intracorneal implants, scleral alterations and pharmacological ocular drops. Untreated presbyopia negatively affects quality of life as well as the world productivity since presbyopia progresses from approximately an age when people are still an active part of the workforce. As the population and life expectancy grow, so will the number of presbyopes. This article will discuss the various options available to treat presbyopia.
Topics: Eyeglasses; Humans; Lens, Crystalline; Lenses, Intraocular; Presbyopia; Quality of Life
PubMed: 35833432
DOI: No ID Found -
Journal Francais D'ophtalmologie Sep 2019Presbyopia is the progressive loss of accommodation. Accommodation is a quick, precise and involuntary action which enables the eye to change the power of the young... (Review)
Review
Presbyopia is the progressive loss of accommodation. Accommodation is a quick, precise and involuntary action which enables the eye to change the power of the young crystalline lens to see clearly at all distances. Presbyopia is and age-linked physiologic phenomenon: it results from aging of the lens, which loses its elasticity, gradually becomes rigid and loses the ability to accommodate. Presbyopia has attained a prevalence of 80% in Europe and is increasing regularly due to the aging of the population. Various surgical techniques can be proposed. Indications depend on age, ophthalmological exam, and any associated ametropia. The main techniques act by either changing the curvature of the cornea with laser or with an intrastromal inlay to create pseudoaccomodation, or by intraocular lens surgery with a multifocal or accommodating IOL. Once the surgical choice has been made, the information must be clearly conveyed and consent obtained.
Topics: Europe; Humans; Ophthalmology; Presbyopia; Refractive Surgical Procedures; Visual Acuity
PubMed: 30857805
DOI: 10.1016/j.jfo.2018.08.009