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Current Opinion in Ophthalmology Jul 2018Presbyopia is an inevitable age-related loss of accommodation that results in spectacle dependence with common everyday near-vision tasks. Many surgical approaches to... (Review)
Review
PURPOSE OF REVIEW
Presbyopia is an inevitable age-related loss of accommodation that results in spectacle dependence with common everyday near-vision tasks. Many surgical approaches to presbyopic correction have been investigated, with monovision correction being amongst the most common and attractive options. In this article, we will review the advantages and disadvantages of the new modalities of presbyopic monovision correction.
RECENT FINDINGS
New methods such as mini-monovision, corneal inlays, and multifocal corneal ablation aim to maximize stereopsis and decrease the anisometropic side effects of conventional monovision. These include inlays such as the KAMRA and Raindrop, and phakic intraocular lenses such as the hole ICL. Newer corneal laser refractive procedures such as small incision lenticule extraction have also shown good outcomes with monovision. Pseudophakic monovision using standard monofocal lenses still provides good results.
SUMMARY
Monovision for presbyopic correction continues to provide promising results. There are a number of new devices and techniques that have shown good visual acuity outcomes, patient satisfaction and spectacle independence.
Topics: Accommodation, Ocular; Cornea; Corneal Surgery, Laser; Depth Perception; Eyeglasses; Humans; Presbyopia; Visual Acuity
PubMed: 29708928
DOI: 10.1097/ICU.0000000000000487 -
Current Opinion in Ophthalmology Jul 2016This review outlines concepts in intraocular lens (IOL) optics and aberrations important both for current IOLs and for new IOLs in development. (Review)
Review
PURPOSE OF REVIEW
This review outlines concepts in intraocular lens (IOL) optics and aberrations important both for current IOLs and for new IOLs in development.
RECENT FINDINGS
Optical aberrations make a significant impact on the laboratory and clinical performance of IOLs, especially under mesopic and low-contrast conditions. Minimizing or correcting these aberrations can potentially improve visual function. Strategic management of aberrations can have clinical utility for extended depth of focus and presbyopia correction.
SUMMARY
All IOLs affect ocular aberrations in some manner. It is important for clinicians and researchers to understand the implications how any residual aberrations could affect visual quality, visual side-effects, and depth of focus.
Topics: Accommodation, Ocular; Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Optics and Photonics; Presbyopia; Refraction, Ocular; Vision, Ocular; Visual Acuity
PubMed: 27093102
DOI: 10.1097/ICU.0000000000000279 -
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 -
Acta Ophthalmologica Sep 2019Albinism degrades visual function due to developmental disorders of the eye and visual pathways, larger refractive errors, absent binocularity and poor fixation control.... (Comparative Study)
Comparative Study
PURPOSE
Albinism degrades visual function due to developmental disorders of the eye and visual pathways, larger refractive errors, absent binocularity and poor fixation control. Reading spectacles is commonly prescribed in our clinic and well tolerated. The purpose was to evaluate whether the accommodative response is typical or affected in comparison to a reference group.
METHODS
Twenty-two children with albinism (median: 13.5 years) and 12 controls (median: 13 years) underwent a full optometric examination and an objective accommodation measurement (WAM-5500 @ 6 Hz; Grand Seiko) in response to minus-lens-blur (-1, -2 and -3 D) and to a prolonged near viewing task (20 cm) for 5 min.
RESULTS
Children with albinism displayed less accommodation to minus lens-blur and during sustained near viewing (p < 0.001) compared to the reference group. Higher visual acuity correlates with a better accommodative response (r ≥ 0.5; p ≤ 0.04). The subjective and objective measures of accommodation did not correlate. The habitual reading distance was always closer than the point towards which the subjects with albinism seemed to accommodate according to the measurements at 20 cm.
CONCLUSION
Children with albinism benefits from reading spectacles due to a combination of close habitual reading distance and a poor accommodation. Objective recording of accommodation is not critical for a correct judgement of near visual function. Children already wearing reading spectacles were those with least accommodative response.
Topics: Accommodation, Ocular; Adolescent; Albinism; Child; Child, Preschool; Eyeglasses; Female; Humans; Infant; Infant, Newborn; Lens, Crystalline; Male; Reading; Refractive Errors; Vision, Binocular; Visual Acuity; Young Adult
PubMed: 30702212
DOI: 10.1111/aos.14040 -
International Ophthalmology Aug 2018To report the pre- and post-operative findings of a case with dysfunctional lens syndrome.
PURPOSE
To report the pre- and post-operative findings of a case with dysfunctional lens syndrome.
METHODS
An adult patient was evaluated using iTrace aberrometer, Tomey topographer and slitlamp biomicroscopy to confirm dysfunctional lens syndrome.
RESULTS
A 45-year-old male patient presented with the chief complaint of poor visual quality; uncorrected visual acuity 20/40 in the right eye, best spectacle corrected visual acuity 20/25 in the right eye with refraction Plano/-1.50 × 80 (SE = -0.75D). Pre- and post-operative root-mean-square (RMS) of total higherorder aberrations in the entire eye, the internal optics and the cornea were 0.350 & 0.257, 0.311 & 0.236 and 0.214 & 0.191 micron (μ), respectively. Also, the magnitude of preoperative total, internal and corneal coma was 0.254 μ × 222°, 0.274μ×242° and 0.097μ × 131° and postoperative values were 0.170 μ × 162°, 0.131 μ × 177°, 0.054 μ × 125°, respectively.
CONCLUSION
These results show that sometime the HOAs of the internal optics, mainly crystalline lens, are not compensated by the cornea and this may cause visual discomfort in the absence of any significant cataract, this situation is known as dysfunctional lens syndrome (DLS).
Topics: Accommodation, Ocular; Corneal Wavefront Aberration; Humans; Lens Diseases; Lens, Crystalline; Male; Middle Aged
PubMed: 28685418
DOI: 10.1007/s10792-017-0622-3 -
Ophthalmic & Physiological Optics : the... May 2021
Topics: Accommodation, Ocular; Activities of Daily Living; Axial Length, Eye; Humans; Hyperopia
PubMed: 33822409
DOI: 10.1111/opo.12819 -
Vision Research Jul 2021Many patients with concussion experience visual symptoms following injury that lead to a diagnosis of convergence insufficiency, accommodative insufficiency, or saccadic...
Many patients with concussion experience visual symptoms following injury that lead to a diagnosis of convergence insufficiency, accommodative insufficiency, or saccadic dysfunction. However, these diagnostic categories are based on aggregates of clinical tests developed from a non-concussed population and therefore may not accurately describe visual deficits in the concussed population. Thus, we sought to understand individual metrics of visual dysfunction in chronically symptomatic post-concussion patients. This retrospective cross-sectional study included patients examined at the multidisciplinary concussion clinic (MDCC) at Boston Children's Hospital over four years. Patients aged 5-21 years who had a complete assessment of eye alignment, vergence, accommodation, and visual tracking, and had visual acuity better than or equal to 20/30 in each eye were included. Patients with history of amblyopia, strabismus, or ocular pathology were excluded. Chart review yielded 116 patients who met inclusion criteria (median age 15 years, 64% female). The majority of patients (52%) experienced a single concussion and most were sports-related (50%). Clinical data show vergence, accommodation, or visual tracking deficits in 95% of patients. A receded near point of convergence (NPC, 70/116) and reduced accommodative amplitude (63/116) were the most common deficits. Both NPC and accommodative amplitude were significantly correlated with one another (r = -0.5) and with measures of visual tracking (r = -0.34). Patients with chronic post-concussion symptoms show deficits in individual metrics of vergence, accommodation and visual tracking. The high incidence of these deficits, specifically NPC and accommodative amplitude, highlights the need for a detailed sensorimotor evaluation to guide personalized treatment following concussion.
Topics: Accommodation, Ocular; Adolescent; Child; Convergence, Ocular; Cross-Sectional Studies; Female; Humans; Male; Retrospective Studies; Vision, Binocular
PubMed: 33838503
DOI: 10.1016/j.visres.2021.03.002 -
[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 -
European Journal of Ophthalmology Jan 2023In recent years, with the gradual maturation of myopia correction surgery, the changes in binocular visual function after surgery have attracted widespread attention.... (Review)
Review
In recent years, with the gradual maturation of myopia correction surgery, the changes in binocular visual function after surgery have attracted widespread attention. The accommodation of facility, the amplitude of accommodation, relative accommodation, and accommodation convergence/accommodation assembly are essential parameters for assessing binocular visual function. The changes in these parameters are significant for guiding patients in the design of the preoperative surgical approach and alleviating postoperative visual fatigue. This paper aims to guide the preoperative assessment, design, and postoperative visual training of refractive surgery in myopic patients from the perspective of changes in binocular visual function before and after myopia and surgery, which can improve accommodation and convergence function in patients after refractive surgery.
Topics: Humans; Convergence, Ocular; Myopia; Refractive Surgical Procedures; Accommodation, Ocular; Vision, Binocular
PubMed: 36203367
DOI: 10.1177/11206721221128993 -
NeuroRehabilitation 2022Visual dysfunctions are common in individuals following concussion/mild traumatic brain injury (C/mTBI). Many deficits have been uncovered in their oculomotor system,... (Review)
Review
BACKGROUND
Visual dysfunctions are common in individuals following concussion/mild traumatic brain injury (C/mTBI). Many deficits have been uncovered in their oculomotor system, such as in the pupil and accommodation.
OBJECTIVE
To describe the static and dynamic abnormalities in the pupillary and accommodative systems in those with C/mTBI. This includes both diagnostic and therapeutic aspects, with emphasis on objectively-based test findings, as well as their basic and clinical ramifications.
METHODS
PubMed, Google Scholar, and Semantic Scholar databases were searched from 1980-2020, using key words of accommodation, pupil, vision therapy, vision rehabilitation, and objective testing, for peer-reviewed papers, as well as related textbooks in the area, in those with C/mTBI.
RESULTS
For both systems, most static and dynamic response parameters were abnormal: they were typically reduced, slowed, delayed, and/or more variable. Most of the abnormal accommodative parameters could be significantly improved with vision therapy.
CONCLUSIONS
For both systems, most response parameters were abnormal, which could explain their visual symptoms and related problems. For accommodation, the improvements following vision therapy suggest the presence of considerable visual system plasticity, even in older adults with chronic brain injury.
Topics: Accommodation, Ocular; Aged; Brain Concussion; Humans; Pupil; Vision Disorders
PubMed: 35311724
DOI: 10.3233/NRE-228011