Correction Of Presbyopia Research Articles

Review of surgical devices using small aperture optics.

Small aperture optics work by blocking unfocused peripheral light rays while allowing central light rays to focus on the retina. This pinhole effect creates an extended depth of focus and has been used in presbyopia correction, improving intermediate and near vision without markedly affecting distance vision. Another beneficial effect of small aperture optics is reducing aberrations caused by irregular corneas or irregular pupils. The first small aperture surgical device was the Kamra corneal inlay used on the nondominant eyes of presbyopic emmetropes. The pinhole concept was also adapted into the IC-8 intraocular lens (IOL) for presbyopia correction during cataract surgery and by the XtraFocus piggyback device to lessen unwanted aberrations in eyes with irregular corneas or pupils. The IC-8 IOL can be placed monocularly or binocularly with mini-monovision for further near vision improvement. The XtraFocus piggyback device can be placed either in the sulcus or capsular bag. The aim of this literature review is to synthesize evidence on the efficacy, safety, and patient-reported outcomes on surgical devices utilizing small aperture optics. A comprehensive search on PubMed was conducted with the keywords “small aperture optics,” “small aperture corneal inlay,” “small aperture IOL,” “Kamra corneal inlay,” “IC-8 IOL,” and “XtraFocus.” In this review, we describe the progression of small aperture surgical devices, patient criteria, visual outcomes, complications, satisfaction, and recommendations for surgical success.

Presbyopia Correction in Cataract Surgery

Presbyopia Correction in Cataract Surgery

An Evaluation of a Cataract Surgical Camp in New Karu L.G.A., Nasarawa State, Nigeria

Aim: To describe the socio-demographic profile of the participants and the ocular pathologies seen during a 3-day free eye screening and cataract surgical camp, to identify the groups we need to create awareness to, and to improve access in subsequent outreaches. Method: A retrospective cross-sectional descriptive study was carried out among 552 participants that attended a cataract surgical outreach camp in New Karu Local Government Area (L.G.A.), Nasarawa State from 10th to 14th September 2013. Data were analyzed using SPSS Version 20 using descriptive analysis such as frequencies and cross-tabulation. P < 0.05 was considered statistically significant. Results: Six hundred and sixty-six people registered and 552 were examined comprising of 205 males and 347 females. The majority (81.7%) were younger than 60 years old, accounting for 4.5 times more than those older than 60. Females were in the majority (63%). Amongst those older than 60 years, males were slightly higher as compared to those younger than 60 years, where females were twice as much. Most of the participants (71.3%) reside within the L.G.A. Amongst those that reside within the L.G.A., females were twice the men and there was a fairly even distribution of both sexes amongst those that reside outside the L.G.A. The majority of the screened participants (41%) required presbyopic correction. Cataract was the second commonest ocular pathology (22.6%) and 53 (9.6%) participants with VA ≤ 6/60 were offered the free cataract surgery. Conclusion: There was an increase in female participation and those younger than 60 years. Amongst those younger than 60 years and those that reside within New Karu L.G.A., female participation was twice as much as males. When the barrier of distance is eliminated, it increases female participation.

The Impact of Near Vision Impairment on Activities of Daily Living Across the Life Course.

The Impact of Near Vision Impairment on Activities of Daily Living Across the Life Course.

Self-motion illusions from distorted optic flow in multifocal glasses

SummaryProgressive addition lenses (PALs) are ophthalmic lenses to correct presbyopia by providing improvements of near and far vision in different areas of the lens, but distorting the periphery of the wearer's field of view. Distortion-related difficulties reported by PAL wearers include unnatural self-motion perception. Visual self-motion perception is guided by optic flow, the pattern of retinal motion produced by self-motion. We tested the influence of PAL distortions on optic flow-based heading estimation using a model of heading perception and a virtual reality-based psychophysical experiment. The model predicted changes of heading estimation along a vertical axis, depending on visual field size and gaze direction. Consistent with this prediction, participants experienced upwards deviations of self-motion when gaze through the periphery of the lens was simulated, but not for gaze through the center. We conclude that PALs may lead to illusions of self-motion which could be remedied by a careful gaze strategy.

Clinical Outcomes and Quality of Vision Associated with Bilateral Implantation of a Wavefront Shaping Presbyopia Correcting Intraocular Lens.

PurposeTo provide normative visual acuity and quality of vision data related to bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens (IOL).Patients and MethodsThis was a non-interventional research study of the refraction, visual acuity (VA) and quality of vision achieved after bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens between 3 months and 12 months post-surgery. The manifest refraction, and uncorrected and distance corrected VA at near, intermediate and distance (40 cm, 50 cm, 66cm, 4 m) were tested. Binocular mesopic VA at 4m and uncorrected photopic low contrast (25%) VA at 4 m were also tested, the latter with and without a glare source. A patient reported outcome questionnaire was administered. Defocus curve testing with and without simulated myopia in the non-dominant eye was also tested (reported elsewhere).ResultsForty subjects completed the study. There was no statistically significant difference between the uncorrected and distance corrected VA at any distance. Mean logMAR binocular VAs were (−0.07 ± 0.07) at 4 m, (0.00 ± 0.07) at 66 cm and (0.07 ± 0.11) at 40 cm. Uncorrected photopic low contrast VA was statistically significantly better without glare (0.09 ± 0.10) compared to with glare (0.44 ± 0.21, p < 0.01). Reported glare, halos and starbursts were “not at all” Or “a little” bothersome for more than 95% of subjects. Hazy vision and blurred vision were reported most often.ConclusionThe Vivity IOL provided patients with good distance and intermediate vision, and functional near vision with low reported bother from glare, halos, or starbursts.

Systematic Review of the Use of Supplemental Multifocal Intraocular Lenses in the Ciliary Sulcus for Presbyopia Correction.

To conduct a critical review of the peer-reviewed literature on the use of supplemental multifocal intraocular lenses in the ciliary sulcus. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. According to the inclusion and exclusion criteria defined, 15 articles were selected for the current systematic review. Each of them was analyzed carefully and their risk of bias was assessed with the Quality Assessment Tool for Case Series Studies from the National Heart, Lung, and Blood Institute. Data of 384 eyes from 227 patients were analyzed. Most of the studies reviewed had a short follow-up and poor or limited design, including case reports, case series, and clinical trials with several gaps in their methodology. Post-operative uncorrected distance and near visual acuity ranged from 20/40 to 20/20 and from 0.4 to 0.02 logMAR, respectively. Pigment dispersion (12 eyes) and deposits (13 eyes) were the most described complication. Dysphotopsia, glare, and halos were the more frequently reported visual disturbances. However, most of the patients reported a high level of satisfaction with their surgery. Most articles reviewed (13 of 15) achieved a risk of bias score between 6 and 8, representing a high level of evidence despite the study design limitations. Supplemental multifocal intraocular lenses seem to offer good distance and near visual results, leading to high levels of spectacle independence and patients' satisfaction, with limited complications associated. However, more studies with a more robust design are needed to confirm these trends. [J Refract Surg. 2021;37(12):830-835.].

Comparison of Visual Performance and Patient Satisfaction After Multifocal Intraocular Lens Implantation and During Multifocal Contact Lens Wear After Monofocal Intraocular Lens Implantation: A Pilot Study.

PurposeTo compare the visual performance and patient satisfaction in multifocal intraocular lens (IOL)-implanted eyes and multifocal contact lens (CL)-wearing eyes undergoing monofocal IOL implantation.MethodsWe retrospectively assessed visual acuity at all distances (0.3, 0.5, 0.7, 1, and 5 m), contrast sensitivity function, patient satisfaction score, and the rate of spectacle independence in the multifocal IOL and multifocal CL groups.ResultsBinocular visual acuity at 0.3, 0.5, 0.7, 1, and 5 m was 0.05 ± 0.11, − 0.02 ± 0.09, − 0.02 ± 0.09, − 0.02 ± 0.09, and − 0.04 ± 0.07, respectively, in the multifocal IOL group and 0.25 ± 0.13, 0.04 ± 0.10, 0.01 ± 0.09, − 0.01 ± 0.07, and 0.00 ± 0.08, respectively, in the multifocal CL group. We found significant differences in visual acuity at all distances. The area under the log contrast sensitivity function was 1.32 ± 0.14 and 1.33 ± 0.16 in the multifocal IOL and CL groups, respectively (p = 0.444). The patient satisfaction score for overall vision was 80.2 ± 20.6 and 82.9 ± 10.5 (p = 0.889), and the rate of spectacle independence was 23.4% and 41.7% in the multifocal IOL and CL groups, respectively (p = 0.277).ConclusionsAccording to our experience, both multifocal IOLs and CLs provided good near-to-distance binocular vision and subsequent high patient satisfaction in daily activities with acceptable contrast sensitivity, suggesting their viability for presbyopic correction in elderly subjects.

An Artificial Lens Capsule with a Lens Radial Stretching System Mimicking Dynamic Eye Focusing.

Presbyopia is a common eye disorder among aged people which is attributed to the loss of accommodation of the crystalline lens due to the increasing stiffness. One of the potential techniques to correct presbyopia involves removing the lens substance inside the capsule and replacing it with an artificial lens. The development of such devices, e.g., accommodating intraocular lenses (AIOLs), relies on the understanding of the biomechanical behaviour of the lens capsule and the essential design verification ex vivo. To mimic the eye’s dynamic focusing ability (accommodation), an artificial lens capsule (ALC), from silicone rubber accompanied by a lens radial stretching system (LRSS) was developed. The ALC was manufactured to offer a dimension and deforming behaviour replicating the human lens capsule. The LRSS was calibrated to provide a radial stretch simulating the change of diameter of capsules during accommodating process. The biomechanical function of the ALC was addressed by studying its evolution behaviour and reaction force under multiaxial stretch from the LRSS. The study highlighted the convenience of this application by performing preliminary tests on prototypes of ophthalmic devices (e.g., AIOLs) to restore accommodation.

Amplitude of accommodation and age of onset of presbyopia in South-East, Nigeria

Objective: To determine the amplitude of accommodation and age of onset of presbyopia among adults in Onitsha, South-East Nigeria. Materials and methods: Participants were selected through multi-stage random sampling from 10 secondary schools in Onitsha. A pre-tested self-administered questionnaire was used to elicit information on participants’ socio-demographic characteristics and ocular health. Ocular examination included distance and near visual acuity tests, refraction, external eye examination, funduscopy and measurement of amplitude of accommodation. Results: Three hundred and forty teachers made up of 63 males (18.5%) and 277 females (81.5%) were studied. The age range was 24 – 60 years; mean: 45.2±7.4SD years. The amplitude of accommodation ranged from 1.8 - 9.8 dioptres; mean: 4.7±2.7SD dioptres. Conclusions: Nigerian adults have lower amplitudes of accommodation than Caucasians of comparable age and may require presbyopic correction earlier than their Caucasian counterpart.

Presbyopia and multifocal contact lenses 2: Prescribing and fitting

In the second of two articles looking at the role that multifocal contact lenses can play in the correction of presbyopia, Professor Kathy Dumbleton, Dr Debbie Laughton and Dr Jennifer Palombi discuss prescribing trends, recommendations for prescribing, supplemental fitting tools and patient satisfaction.

Opportunities and threats to contact lens practice: A global survey perspective

AimTo understand the views of contact lens (CL) practitioners across the globe regarding what they perceive as opportunities and threats in CL practice. MethodsA self-administered anonymised questionnaire, constructed in English and translated in six more languages, was distributed through reputed international professional bodies and academic institutions worldwide. The questionnaire included items on demographic characteristics, type of practice, and questions designed to explore practitioners’ perspective on the future of their CL practice over the next five years. ResultsA total of 2408 valid responses were analysed. Multifocal CLs for presbyopia, CLs for myopia control, use of daily disposable (DD) CLs for occasional wear, and biocompatible materials to improve comfort were identified as promising areas of opportunities by practitioners (all 8/10). Respondents from North America, and Europe valued DDCLs for occasional wear moderately more favourable (Median: 9/10 for all) as compared to colleagues in Asia (Median: 8/10, p < 0.001), South America (Median: 8/10, p < 0.01), and Africa (Median: 8/10p < 0.01). Multifocal CLs for presbyopia was perceived as a better opportunity by practitioners in North America and Europe (Median: 9/10 for both), as well as in Australasia (Median: 8/10), in comparison to Asia, Africa, and Middle East (for all Median: 6/10, p < 0.001). Practitioners expressed concerns about the availability of CLs and CL prescriptions online without direct professional involvement (both 9/10). ConclusionsOverall, the most appealing opportunities for CL practice growth were identified in occasional use of DD CLs, biocompatible materials to reduce CL discomfort, multifocal CLs for presbyopia correction and management of myopia control with CLs. Lack of regulation in CL sales, especially online, seemed to be a constant threat. The insights from this study can be used to design targeted strategies to enhance CL practice across the globe and in specific geographical areas.

Principles of Accommodation and Technology Update of Presbyopia Corrections using IR and UV Lasers

Purpose: To update and review the technology and principles of laser presbyopia reversal (LAPR) via sclera ablation and thermal shrinkage using infrared and UV lasers. Recent clinical data and new methods are also summarized.&#x0D; Study Design: LAPR using laser sclera ablation for increased accommodation of presbyopic eyes.&#x0D; Place and Duration of Study: New Taipei City, Taiwan, between June, 2021 and July, 2021.&#x0D; Methodology: Accommodation gain was obtained by laser scleral ablation of an eye using Er:YAG laser (at 2.94 um) using either line-pattern or dots-pattern outside the limbus in the oblique quadrants of an eye. The principles of accommodation and the key factors influencing the outcomes are discussed. The accommodation gain (AG) after the surgery is mainly due the change in anterior curvature and anterior shift of the lens. The effectiveness of ciliary body contraction for lens relaxation (or accommodation) may be influenced by the combined aging factors, including lens property changes (index, size, thickness and curvature), tissue elastic changes (in sclera and ciliary) and the zonular tension change. Classical theories of accommodation include Helmholtz and Schachar hypothesis. The key issues and new directions to overcome the drawbacks of the existing LAPR procedure (based on scleral ablation) are proposed. Clinical outcomes from two major groups, SurgiLight and Ace Vision, with two years follow are summarized.&#x0D; Results: Clinical outcomes during 2000 to 2020 are summarized showing an average Accommodation gain about 2.0 D, and postoperative egression about 0.25 D (after two years).&#x0D; Conclusion: Laser presbyopia reversal (LAPR) via sclera ablation using infrared laser is safe and effective, but suffers drawbacks of being invasive and procedures are too slow. New directions are required for improved outcomes.

Prevalence and factors associated with uncorrected presbyopia in a rural population of Japan: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study.

To investigate the prevalence and factors associated with uncorrected presbyopia among rural community dwellers in Japan. A population-based cross-sectional study was conducted in 2011 among community dwellers aged 40-74years who received specific health checkups in Minamiaizu and Tadami, Fukushima Prefecture, Japan. Uncorrected presbyopia was considered as when the distance-corrected visual acuity in the better eye was ≥0.5 and the near-presenting visual acuity in the better eye was <0.4, regardless of distance refractive status. Multiple logistic regression analysis was employed to calculate the odds ratios (ORs) for uncorrected presbyopia and to adjust for possible confounders. A total of 2054 individuals participated in the specific health checkups. In the 1156 individuals (response rate: 56.28%) analyzed in the study, the mean (SD) age was 63.0 (8.7) years, the percentage of women was higher (57.87%), and the prevalence of uncorrected presbyopia was 26.38% (95% CI 23.86%-29.03%). Multivariate analysis revealed that the factors associated with uncorrected presbyopia were older age (adjusted OR: 1.054 [95% CI: 1.034-1.075]), female sex (adjusted OR: 1.388 [95% CI: 1.006-1.915]), and distance-presenting vision impairment (adjusted OR: 2.651 [95% CI: 1.697-4.143]). Approximately one-quarter of the participants in this study from a rural population of Japan did not have adequate near vision. It is recommended that a public health intervention should be enacted to correct presbyopia, especially in the older age group, women, and those with uncorrected refractive errors.

Presbyopia and multifocal contact lenses 1: Attitudes and beliefs

In the first of two articles discussing multifocal contact lenses, Professor Kathy Dumbleton, Dr Debbie Laughton and Dr Jennifer Palombi provide an overview of current attitudes and beliefs relating to presbyopia and contact lens correction. (C 78718, one distance learning CET point suitable for optometrists, contact lens opticians and dispensing opticians)

Digitized optofluidic element and its application to tristate lens for presbyopia correction

Current optofluidic devices are analog focus-tunable elements with a continually varying focus between foci. An innovative digitized optofluidic element was developed to enable fast switching between the foci. The operation involves an internally placed elastic membrane of changing shape between the refractive and diffractive forms with a tiny amount of fluid transfer by a micro-actuator. This allows for switching the digitized optofluidic element between the refractive and diffractive states of the preset optical powers. A multimodal relief surface design was used in the diffractive state to manage the diffractive grooves and improve the chromatic characteristics. We applied finite element analysis to establish the membrane mechanical properties. The proof-of-concept prototypes were made using material bonding fabrication processes and were used to demonstrate an elastic membrane shape change between the refractive and diffractive forms for switching between the corresponding optical states. The design of the digitized optofluidic element allowed for bistate or tristate switching by a single actuator. The switchable element can be fairly thin, enabling conversion of a fixed lens into a dynamic lens switchable between two or three foci. The application of the tristate design to eyewear for presbyopia correction is discussed.

Understand the Patients’ Attitude towards Presbyopia and the various Lenses Correction Options

Aim: To reveal the patients point of view about the selection of different presbyopic correction options from ophthalmic lenses and awareness about presbyopia. Methodology: In this Prospective study, feedback questionnaire based study in North India, 126 subjects were enrolled and the offline questionnaire and responses were recorded. Participants’ age ranged between 37 -75 years (using near correction). Evaluated the responses to know the reasons of chosen of different options for pre-presbyopia and presbyopia correction by the subjects and attitudes about it, its importance, and present conventional correction opinions including bifocals, progressive addition lenses and contact lenses. Result: Among the all participants, number of participants between the age group 37- 45 (pre-presbyopes) were 35 (27.77%), between 45-55 years of aged group were 60 (47.61%) participants and rest of 31 (24.60%) participants were between 55-75 years of aged group. Forty eight participants (38.1%) were already wearing a near correction while seventy eight (61.9%) were not wear any near correction. Out of 126, the 6 (4.76%) subjects were chosen a near visual correction and separated glasses, 88 (69.84%) subjects were chosen the bifocal lenses, rest of all 32 (25.89%) subjects chosen the PALs. And no one was using contact lens for near correction. Few similarities were observed as age–related (75.38%), total unaware of word presbyopia (85.71%), comfort, convenience and appearance concerned (63%). Conclusion: The spectacles were most preferred for the correction of presbyopia. Bifocals are taken by majority of population. After educating about Presbyopia and advantages of PALs, it was revealed that most of the subjects wanted to choose PALs because of comfort and convenience to see all distances but most of them denied due to cost and 4-8 days adaptation time. So most of the subjects were chosen the bifocal lenses even they knew the disadvantages of it like image jump and segment line, while comfort, convenience and cosmetic appearance were seen as the preferred than cost. But cost also played role while finalize the lens and its coatings types.

Future Trends in Presbyopia Correction.

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. [J Refract Surg. 2021;37(6 Suppl):S28-S34.].

Multifocal Spectacle and Monovision Treatment of Presbyopia and Falls in the Elderly.

Presbyopia is an age-related condition that affects approximately 1.8 billion people worldwide. Strategies to correct presbyopia include both nonsurgical and surgical approaches. Although eye care providers assume that multifocal spectacles and monovision have lower risks than surgical interventions, there is evidence to suggest that the use of these nonsurgical approaches in the older population increases the risk for trips and falls. Each year, fall-related injuries and deaths are reported in a substantial portion of the population, both globally and in the United States. Previous studies have shown a link between visual acuity, contrast sensitivity, stereoacuity, and visual field impairments and falls. More recent mechanistic and epidemiological studies have shown that multifocal spectacles and monovision can increase the risk for falls as well. Although evidence on the financial burden of falls related to multifocal spectacles or monovision is limited, total direct medical costs related to falls associated with multifocal spectacles are estimated to be approximately $11 billion annually in the United States. Therefore, it is important that eye care providers consider the risk for falls associated with multifocal spectacles and monovision when making decisions on the best strategy for correcting presbyopia in older adults. [J Refract Surg. 2021;37(6 Suppl):S12-S16.].

Visual performance with multifocal contact lenses and progressive addition spectacles

PurposeAs presbyopia occurs, new visual demands create a need for clear vision at multiple distances. Many spectacle wearers adapt into progressive addition lenses (PAL) in order to see clearly at distance, intermediate, and near. A multifocal contact lens provides the ability to see at these same distances without the prismatic effects of a spectacle lens or the peripheral obstruction of a spectacle frame. No studies have been done to date comparing the effect of these types of presbyopic vision correction on a variety of tests of visual performance representative of everyday tasks. MethodsA battery of visual performance tasks were completed by subjects while wearing their habitual PAL spectacles. These subjects were then fit with a multifocal contact lens and wore lenses for 2 weeks or more before completing the tasks again. These functional vision tests included assessments of coincidence anticipation timing, peripheral search and hand-eye coordination, and dynamic visual acuity. Following functional vision testing, subjects completed a preference survey comparing both types of refractive correction while performing common activities of daily living. ResultsPerformance on the majority of the tests of visual performance were equivalent (P < 0.05) when comparing PAL spectacles and multifocal contact lenses. Survey results demonstrated a preference for multifocal contact lenses overall. ConclusionPAL spectacles are widely prescribed for presbyopic patients. The findings of this study suggest that in addition to providing excellent vision, multifocal contact lenses provide functional vision performance equal to PAL spectacle wear and patients may prefer them over PAL spectacles.