-
[Zhonghua Yan Ke Za Zhi] Chinese... Nov 2022Presbyopia is a physiological aging situation that the plasticity and elasticity of the lens and the function of the ciliary muscle become weaker, resulting in a... (Review)
Review
Presbyopia is a physiological aging situation that the plasticity and elasticity of the lens and the function of the ciliary muscle become weaker, resulting in a decreased accommodation and inability to focus on near objects. Nowadays, there are many clinical strategies to correct presbyopia, each of which has its own advantages and disadvantages, however, there is no true sense of way to restore accommodation function. This article reviews both worldwide and domestic research on presbyopia, and analyzes and summaries the status quo as well as research progress of presbyopia correction modalities, surgical approaches, and drug therapies, hoping to provide a reference for clinical works.
Topics: Humans; Presbyopia; Accommodation, Ocular; Lens, Crystalline; Ciliary Body; Aging
PubMed: 36348549
DOI: 10.3760/cma.j.cn112142-20220316-00120 -
Archivos de La Sociedad Espanola de... Sep 2017Presbyopia is the most prevalent refractive error. With a progressive aging population, its surgical correction is an important challenge for the ophthalmology... (Review)
Review
INTRODUCTION
Presbyopia is the most prevalent refractive error. With a progressive aging population, its surgical correction is an important challenge for the ophthalmology community, as well as the millions of patients who suffer from it, and who are increasingly demanding alternatives to its correction with glasses or contact lenses.
MATERIAL AND METHODS
A review is presented with a synthesised discussion on the pathophysiological theories of presbyopia and an updated and analytical description of the non-lens involvement surgical techniques used to treat presbyopia.
RESULTS
Corneal procedures include various types of corneal implants and photo-ablative techniques that generate a multifocal cornea, or monovision. Scleral procedures exert a traction on supralenticular sclera that supposedly would improve the amplitude of accommodation.
CONCLUSIONS
None of the techniques are able to completely eliminate the need for near -vision glasses, but many of them manage to improve the refractive status of the patients. More studies with rigorous and standardised methods and longer follow-up are needed to evaluate the changes in the near vision of the patients, in order to corroborate the real and practical usefulness of many of these techniques.
Topics: Humans; Ophthalmologic Surgical Procedures; Presbyopia
PubMed: 28624312
DOI: 10.1016/j.oftal.2017.04.005 -
Journal of Refractive Surgery... Dec 2019To summarize the pharmacological strategies that are being explored for presbyopia correction. (Review)
Review
PURPOSE
To summarize the pharmacological strategies that are being explored for presbyopia correction.
METHODS
The review concentrates on pharmacologically induced pupillary miosis to increase depth-of-focus and lens softening or other measures to restore active accommodation.
RESULTS
Several studies suggest that near vision improves and distance vision is unaffected for many hours after either monocular or binocular instillation of any one of several drug combinations that cause miosis. Unfortunately, in most studies, measurements were limited to photopic visual acuity for near and distance vision, whereas it is anticipated that pupil constriction may have adverse effects on mesopic and scotopic vision. It is not clear whether improved near vision was due entirely to increased depth-of-focus, or whether, for example, a drug-induced myopic shift in refraction was also involved. Currently, no study has provided direct evidence for drug-induced restoration/enhancement of true accommodation involving an ocular power change.
CONCLUSIONS
Although it is possible that, in the future, pharmacological drops may offer a safe and reliable solution for presbyopia correction, more evidence of their effectiveness and limitations is required. [J Refract Surg. 2019;35(12):803-814.].
Topics: Accommodation, Ocular; Adrenergic alpha-Agonists; Anti-Inflammatory Agents, Non-Steroidal; Depth Perception; Histamine Antagonists; Humans; Miosis; Muscarinic Agonists; Parasympatholytics; Pharmaceutical Preparations; Presbyopia; Sympathomimetics
PubMed: 31830297
DOI: 10.3928/1081597X-20191010-04 -
Ophthalmic & Physiological Optics : the... Jan 2016
Topics: Humans; Lenses, Intraocular; Optics and Photonics; Presbyopia
PubMed: 26769325
DOI: 10.1111/opo.12272 -
Asia-Pacific Journal of Ophthalmology... 2017With an explosive increase in the worldwide prevalence of presbyopia, development of an accommodating intraocular lens (IOL) with expansive accommodative amplitude... (Review)
Review
With an explosive increase in the worldwide prevalence of presbyopia, development of an accommodating intraocular lens (IOL) with expansive accommodative amplitude remains the holy grail in lens-based refractive surgery. A dynamic change in the dioptric power of the eye can be accomplished by various strategies alone or in combination, including changes in the position, shape, or refractive index of a single- or dual- optic IOL. This article reviews the cumulative advances in these various lens designs, along with clinical outcomes and complications of those that have been implanted. The challenges that remain in each cat-egory are also highlighted.
Topics: Accommodation, Ocular; Humans; Lenses, Intraocular; Optics and Photonics; Postoperative Period; Presbyopia; Prosthesis Design
PubMed: 28650131
DOI: 10.22608/APO.2017198 -
Journal of Cataract and Refractive... Mar 2015
Topics: Accommodation, Ocular; Anterior Eye Segment; Diagnostic Techniques, Ophthalmological; Humans; Presbyopia
PubMed: 25804576
DOI: 10.1016/j.jcrs.2015.02.003 -
Survey of Ophthalmology 2014Advances in small incision surgery have enabled cataract surgery to evolve from being concerned primarily with the safe removal of the opaque crystalline lens to a... (Review)
Review
Advances in small incision surgery have enabled cataract surgery to evolve from being concerned primarily with the safe removal of the opaque crystalline lens to a procedure refined to yield the best possible postoperative refractive result. As the outcomes of cataract surgery have improved, the use of lens surgery as a refractive modality in patients without cataracts (clear lens extraction) has increased in popularity. The removal of the crystalline lens for refractive purposes, or so-called refractive lens exchange (RLE), offers distinct advantages over corneal refractive surgery in selected cases. Nevertheless, in some middle-aged patients with high refractive errors, corneal refractive surgery can be a safe and effective treatment. In addition, the use of multifocal lenses offers an alternative for the correction of presbyopia. A further advantage of RLE is that it simultaneously eliminates the need for cataract surgery in the future. The keys for success in RLE are effectiveness and consistency in the refractive outcome, providing at the same time surgical and postoperative safety. To achieve these goals, adequate indications following strict risk/benefit criteria and refractive precision based on accurate preoperative protocols for IOL calculation and selection are mandatory, together with an appropriate choice of surgical procedure based on the surgeon's skills, minimizing complications.
Topics: Humans; Lens Implantation, Intraocular; Lens, Crystalline; Lenses, Intraocular; Postoperative Complications; Presbyopia; Refractive Surgical Procedures; Risk Assessment
PubMed: 25127929
DOI: 10.1016/j.survophthal.2014.04.004 -
Insight (American Society of Ophthalmic...
Review
Topics: Accommodation, Ocular; Humans; Presbyopia; Quality of Life; Risk Factors; Visual Acuity
PubMed: 30074720
DOI: No ID Found -
Current Opinion in Ophthalmology Jan 2017Presbyopia and cataract development are changes that ubiquitously affect the aging population. Considerable effort has been made in the development of intraocular lenses... (Review)
Review
PURPOSE OF REVIEW
Presbyopia and cataract development are changes that ubiquitously affect the aging population. Considerable effort has been made in the development of intraocular lenses (IOLs) that allow correction of presbyopia postoperatively. The purpose of this review is to examine the benefits and barriers of accommodating IOLs, with a focus on emerging technologies.
RECENT FINDINGS
True accommodation of an IOL involves a dynamic increase in dioptric power to affect a shift from distance to intermediate or near focus. The Crystalens (Crystalens Bausch and Lomb, Inc., Rochester, NY, USA) was the first IOL labeled by the FDA as an accommodating IOL. Further studies have suggested that the Crystalens and several other single optic presbyopia-correcting IOLs may be providing improved intermediate or near vision predominantly through pseudoaccommodative mechanisms, in addition to small changes in axial translation. In light of these findings, a more objective demonstration of accommodation is now required for an IOL to have an accommodative label. Newer technology accommodating IOLs in development have embraced design strategies using dual optics, shape-changing optics, and IOLs with dynamic changes in refractive index. Prevention and treatment algorithms for capsular contraction syndromes unique to Crystalens and Trulign IOL designs will be discussed.
SUMMARY
Accommodating IOLs that are in current use are constrained by their low and varied amplitude of accommodation. Such limitations may be circumvented in the future by accommodative design strategies that rely more on shape-related changes in the surfaces of the IOLs or in dynamic changes in refractive index than by forward translation alone.
Topics: Accommodation, Ocular; Cataract Extraction; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Optics and Photonics; Postoperative Period; Presbyopia; Prosthesis Design
PubMed: 27653608
DOI: 10.1097/ICU.0000000000000323 -
Drugs & Aging Feb 2023Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three...
Accommodation is the change in dioptric power of the eye. It is a dynamic process that allows focusing on an object at all distances. In order to focus sharply, three physiological responses, known as the triad of accommodation, are produced by a change in pupil size, a change in shape and position of the lens, and ocular convergence. This is modulated by the autonomic nervous system, mainly the parasympathetic nervous system. Presbyopia is a refractive condition that occurs with aging, usually manifesting around 40-50 years of age, and is a result of the loss of accommodation in the eye, causing loss of visual performance when focusing on objects placed at different distances, starting with near vision. Glasses, contact lenses, surgical approaches and now pharmacological treatments are accepted methods of treating presbyopia. Pharmacological treatment is a promising new noninvasive option for treating presbyopia. Currently there are three pharmacological approaches to the treatment of presbyopia. The first one aims to produce miosis and, from a pinhole effect, increase depth of focus, and therefore improve uncorrected near visual acuity (UNVA). The second one addresses rehabilitating accommodation in a binocular way, allowing good vision at all distances. Finally, the third strategy uses lipoic acid to restore the lost elasticity of the lens. All of these pharmacological treatments are topical non-invasive eyedrops, with no serious adverse effects having been reported with any of the strategies, and require the right patient selection process to fulfill expectations and needs. The aim of this article is to provide an update on recent advances in this field.
Topics: Humans; Presbyopia; Visual Acuity; Aging
PubMed: 36670320
DOI: 10.1007/s40266-022-01002-4