The effect on income of providing near vision correction to workers in Bangladesh: The THRIVE (Tradespeople and Hand-workers Rural Initiative for a Vision-enhanced Economy) randomized controlled trial.

INTRODUCTION: Presbyopia, the leading cause of vision impairment globally, is common during working years. However, no trials have assessed presbyopia's impact on income. METHODS: In April 2017, we conducted a census among 59 Bangladesh villages to identify persons aged 35 to 65 years with presbyopia (presenting distance vision > = 6/12 bilaterally and correctable inability to see 6/13 at 40 cm with both eyes), who never had owned glasses. Participants were randomized (1:1) to receive immediate free reading glasses (intervention) or glasses delivered 8 months later (control). Visual demand of different jobs was stratified into three levels. Outcomes were between-group differences in the 8 month change in: self-reported monthly income (primary) and Near Vision Related Quality of Life (NVRQOL, secondary). RESULTS: Among 10,884 census participants, 3,655 (33.6%) met vision criteria and 863 (23.6%) comprised a sample enriched for near vision-intensive jobs, but 39 (4.52%) could not be reached. All participants allocated to intervention (n = 423, 51.3%) and control (n = 401, 48.7%) received the appropriate intervention, and follow-up was available for 93.4% and 96.8% respectively. Groups were similar at baseline in all characteristics: mean age was 47 years, 50% were male, 35% literate, and about half engaged in "most near vision-intensive" occupations. Glasses wear at 8-month follow-up was 88.3% and 7.81% in intervention and control respectively. At baseline, both the intervention and control groups had a self-reported median monthly income of US$35.3. At endline, the median income for the intervention group was US$47.1 compared with US$35.3 for control, a difference of 33.4%. Predictors of greater income increase in multivariate models included intervention group allocation (OR 1.45, 95% CI 1.12, 1.88, P = 0.005), male sex (OR 2.41, 95% CI 1.84, 3.16, P <0.001), and not engaging in income-producing work at baseline (OR 2.35, 95% CI 1.69, 3.26, P<0.001). CONCLUSION: Provision of reading glasses increases income in near vision-intensive occupations, and may facilitate return to work for those currently unemployed.

2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management.

ABSTRACT: Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.

Objective and subjective assessment of accommodative insufficiency.

SIGNIFICANCE: A variety of subjective and objective procedures are available to measure the amplitude of accommodation. However, it is unclear whether the standard criterion of Hofstetter's minimum minus 2 D can be used to diagnose accommodative insufficiency with each of these techniques. PURPOSE: The use of objective dynamic retinoscopy and three subjective techniques to diagnosis accommodative insufficiency was examined. METHODS: A total of 632 subjects between 8 and 19 years of age were enrolled. Accommodative lag, monocular accommodative facility, and subjective (push-up, modified push-down, and minus lens) and objective (dynamic retinoscopy) amplitude of accommodation were quantified. Accommodative insufficiency was diagnosed based on Hofstetter's minimum minus 2 D for each subjective method, as well as adding an additional subjective criterion (either accommodative lag exceeding 0.75 D or monocular accommodative facility falling below the age-expected norms). RESULTS: The prevalence of accommodative insufficiency was lowest and highest with the push-up (7.9 and 1%) and dynamic retinoscopy (94 and 12%) procedures when measured without and with the additional subjective criteria, respectively. Comparing the validity of dynamic retinoscopy against the traditional criterion, moderate to low sensitivity and high specificity were found. However, adding the additional subjective criteria improved the findings with moderate to high sensitivity and high specificity. Using a cutoff for dynamic retinoscopy of 7.50 D showed moderate diagnostic accuracy based on likelihood ratios. CONCLUSIONS: It is clear that a revised definition of accommodative insufficiency is required, which must include the method of assessing accommodation. The various objective and subjective methods for quantifying the amplitude of accommodation are not interchangeable, and subjective assessment does not provide a valid measure of the accommodative response.

Nationwide Rapid Assessment of Avoidable Blindness (RAAB) in Armenia.

PURPOSE: This study aimed to estimate the prevalence and main causes of blindness and visual impairment in population aged 50 years and older in Armenia using Rapid Assessment of Avoidable Blindness (RAAB) methodology. METHODS: The study team randomly selected 50 clusters (each consisting of 50 people) from all 11 regions of Armenia. Data on participants' demographics, presenting visual acuity, pinhole visual acuity, principal cause of presenting visual acuity, spectacle coverage, uncorrected refractive error (URE), and presbyopia were collected using the RAAB survey form. Four teams of trained eye care professionals completed data collection in 2019. RESULTS: Overall, 2,258 people of 50 years and older participated in the study. The age- and gender- adjusted prevalence of bilateral blindness, severe and moderate visual impairment were 1.5% (95% CI: 1.0-2.1), 1.6% (95% CI: 1.0-2.2) and 6.6% (95% CI: 5.5-7.7), respectively.The main causes of blindness were cataract (43.9%) and glaucoma (17.1%). About 54.6% and 35.3% of participants had URE and uncorrected presbyopia, respectively. The prevalence of bilateral blindness and functional low vision increased with age and was the highest in participants 80 years and older. CONCLUSION: The rate of bilateral blindness was comparable with findings from countries that share similar background and confirmed that untreated cataract was the main cause of blindness. Given that cataract blindness is avoidable, strategies should be developed aiming to further increase the volume and quality of cataract care in Armenia.

Visual quality assessment and comparison of two multifocal scleral lens designs.

PURPOSE: To analyze the visual quality of a new multifocal scleral lens with a customized decentred optic zone compared to a conventional design by measuring visual acuity, contrast sensitivity function, stereopsis, subjective vision and comfort after one month of wear. METHODS: Nineteen presbyopic subjects were fitted with two multifocal scleral lens designs: a conventional multifocal and a customized decentred optical zone design. All subjects wore both scleral lens designs for one month with a two-week washout period. The main variables evaluated included high and low-contrast visual acuity under photopic and mesopic light conditions, binocular defocus curves, contrast sensitivity function and a visual analogue scale (VAS) for subjective vision and comfort. RESULTS: Comparing the two scleral lens designs, statistically significant differences in visual acuity were found, highlighting the improvement in more than one chart line (6 letters) for low contrast near tests under photopic light conditions with the decentred optics lens design. VAS questionnaire scores also showed a significant improvement in distance and overall subjective vision with the decentred optics lenses. Contrast sensitivity function showed an improvement with decentred multifocal lenses at all spatial frequencies measured, being statistically significant for 12 cycles per degree. No differences in stereoacuity were found. CONCLUSION: Multifocal scleral lenses with a customized decentred optical zone proved to be a promising refractive correction in presbyopic subjects after one month of wear, offering good comfort and visual quality under photopic and mesopic light conditions.

Multivariate analysis of repeatability for the Near Eye Tool for Refractive Assessment (NETRA).

OBJECTIVE: To investigate repeatability of refractive state using a smartphone-based assessment tool, the Near Eye Tool for Refractive Assessment (NETRA). METHODS AND ANALYSIS: This study included 279 participants, predominantly female (66.7%) of African descent (49.1%). The age range was 9-63 years with mean age (s) 22.6 (8.9) years. Two consecutive measurements per eye with the NETRA were measured for both eyes of all participants. However, analyses for the right eyes only are included here. Multivariate statistical analysis included stereo-pair comets and scatterplots with 95% surfaces of constant probability density. Correlation coefficients for repeated samples were determined. Repeatability and agreement for NETRA were assessed with Bland-Altman plots, coefficients of repeatability ([Formula: see text] ; [Formula: see text] is the SD of differences) and intraclass correlation coefficients (ICCs). RESULTS: Bland-Altman plots, within-subject SD (sw ), coefficients of repeatability and ICC indicated that repeated measurements were similar for many but not all eyes and there was good agreement (ICC=0.96) for the spherical coefficient (F I=M) but less so for antistigmatic coefficients (F J=J 0 and F K=J 45) of power. Although mean differences for repeated samples were almost zero, 95% limits of agreement widths were larger for the stigmatic coefficients. Without cycloplegia, repeatability (2.77sw ) was 1.63 D, 0.58 D and 0.56 D for the stigmatic and antistigmatic coefficients, respectively. CONCLUSION: NETRA is a potentially useful and inexpensive portable method in clinical and primary health settings, and especially in less-developed regions of the world. The subjective nature of the self-refraction task can be challenging for younger individuals, and cycloplegia is recommended for NETRA with such patients.

Standard Clinical Outcomes, Light Distortion, Stereopsis, and a Quality-of-Life Assessment of a New Binocular System of Complementary IOLs.

PURPOSE: To evaluate the visual outcome, light distortion index (LDI), and quality of life (QoL) of patients implanted with two complementary intraocular lenses (IOLs) to treat cataract and presbyopia. METHODS: Twenty-seven consecutive patients with cataract were treated with the implantation of the Artis Symbiose Mid (Mid) IOL (Cristalens Industrie) in the distance-dominant eye and the Artis Symbiose Plus (Plus) IOL (Cristalens Industrie) in the contralateral eye following phacoemulsification. The primary objective was to ascertain the monocular and binocular defocus curves. Secondary endpoints included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity, and distance-corrected intermediate visual acuity at 90 and 70 cm, uncorrected near visual acuity and distance-corrected visual acuity at 40 cm, contrast sensitivity, LDI with a halometer, stereopsis, and patients' QoL with the validated Visual Function Index (VF-14) questionnaire. These measurements were collected in two visits, at 4.14 ± 3.13 and 10.30 ± 3.14 months postoperatively. RESULTS: Statistically significant differences in the monocular defocus curves were found at the defocus steps of -1.00, -1.25, -1.50, -1.75, -2.50, -2.75, -3.00, -3.50 diopters and the -4.00 diopters (P < .050). The mean binocular defocus curve was 0 logMAR or better from the +0.50 to the -2.50 D defocus steps. Contrast sensitivity was within normal values. The LDI was 12.57 (6.61)% for the Mid eyes, 14.99 ± 5.70% for the Plus eyes, and 10.36 ± 4.42% binocularly. The patients' stereopsis was 40.0 (12.5) arc-seconds. The QoL score was 95.99 (7.14) at 10 months. CONCLUSIONS: The implantation of the Artis Symbiose IOLs was a safe and effective treatment for presbyopia compensation in patients with cataract. Both IOLs are complementary and may produce a binocular depth-of-field of 3.00 diopters over 0 logMAR when used together. [J Refract Surg. 2023;39(10):654-661.].

Multifocal versus modified monovision corrections: A non-dispensing comparison of visual assessment in presbyopic neophytes.

Purpose: To compare the visual performance of two simultaneous-vision soft multifocal contact lenses and to compare multifocal contact lens and its modified monovision counterpart in presbyopic neophytes. Methods: A double-masked, prospective, comparative study was conducted on 19 participants fitted with soft PureVision2 multifocal (PVMF) and clariti multifocal (CMF) lenses in random order. High- and low-contrast distance visual acuity, near visual acuity, stereopsis, contrast sensitivity, and glare acuity were measured. The measurements were conducted using multifocal and modified monovision design with one brand and then repeated with another brand of lens. Results: High-contrast distance visual acuity showed a significant difference between CMF (0.00 [-0.10-0.04]) and PureVision2 modified monovision (PVMMV; -0.10 [-0.14-0.00]) correction (P = 0.003) and also between CMF and clariti modified monovision (CMMV; -0.10 [-0.20-0.00]) correction (P = 0.002). Both modified monovision lenses outperformed CMF. The current study did not show any statistically significant difference between contact lens corrections for low-contrast visual acuity, near visual acuity, and contrast sensitivity (P > 0.01). Stereopsis at near distance was significantly lower with both modified monovision (PVMMV: 70 [50-85]; P = 0.007, CMMV: 70 [70-100]; P = 0.006) and with CMF (50 [40-70]; P = 0.005) when compared to spectacles (50 [30-70]). Glare acuity was significantly lower with multifocal (PVMF: 0.46 [0.40-0.50]; P = 0.001, CMF: 0.40 [0.40-0.46]; P = 0.007) compared with spectacles (0.40 [0.30-0.40]), but no significant difference was noted between the multifocal contact lenses (P = 0.033). Conclusion: Modified monovision provided superior high-contrast vision compared to multifocal correction. Multifocal corrections performed better for stereopsis when compared to modified monovision. In parameters like low-contrast visual acuity, near acuity, and contrast sensitivity, both the corrections performed similarly. Both multifocal designs showed comparable visual performances.

ESCRS Clinical Trends Survey 2016-2021: 6-year assessment of practice patterns among society delegates.

PURPOSE: To evaluate clinical opinions and practice patterns of delegates to the ESCRS. SETTING: Clinical Trends Surveys were administered during annual ESCRS congresses held between 2016 and 2021, and data collected online and in-person. DESIGN: Survey questions addressed several specialty areas, including cataract surgery, presbyopia-correcting and toric intraocular lenses (IOLs), ocular surface disease, and glaucoma. METHODS: Survey results were compared and analyzed across 6 years. 4 main profile questions were used for cross-tabulation analyses of questions pertaining to refractive surgery-practice location, years in practice, primary surgery setting, and average annual volume of cataract surgery. RESULTS: The highest number of responses (3019) was collected in 2019, with the lowest (569) received in 2020. The use of presbyopia-correcting and toric IOLs has increased significantly from 2016 to 2021, with certain respondent segments using them more frequently than others. Although optical biometry remains the preferred method for obtaining preoperative measurements, the use of tomography (Scheimpflug) has significantly increased. In 2021, 61.1% and 44.9% of respondents always performed preoperative checks of the ocular surface before refractive and cataract surgery, respectively. The number of respondents who perform glaucoma surgery has significantly decreased over the years, with an increasing number of delegates reporting having only a medical glaucoma practice. On average, 5.4% of patients with cataract and glaucoma underwent combined minimally invasive glaucoma surgery and cataract procedures in 2021. CONCLUSIONS: Evaluation of the Clinical Trends Survey data provides valuable insights into the shifting practice patterns and clinical opinions of ESCRS delegates.

Global, regional, and national years lived with disability due to blindness and vision loss from 1990 to 2019: Findings from the Global Burden of Disease Study 2019.

Purpose: This study aimed to provide a comprehensive assessment of burden estimates and the secular trend of blindness and vision loss, as measured by years lived with disability (YLDs), at the global, regional, and national levels. Methods: The age-standardized YLD rates (ASYRs) due to blindness and vision loss and its subtypes, including moderate vision loss, severe vision loss, blindness, and presbyopia, from 1990 to 2019 were extracted from the Global Burden of Disease Study 2019 database. The estimated annual percentage changes (EAPCs) were calculated to quantify the temporal trends in the ASYRs due to blindness and vision loss. Results: In 2019, the global ASYRs per 100,000 population was 327.98 for blindness and vision loss, specifically, 85.81 for moderate vision loss, 74.86 for severe vision loss, 95.03 for blindness, and 62.27 for presbyopia. From 1990 to 2019, the ASYRs due to blindness and vision loss slightly decreased. Females showed higher ASYRs than males in 2019. The global highest ASYRs were observed in South Asia and sub-Saharan Africa. Negative associations were found between the burden estimates of blindness and vision loss and the sociodemographic index levels. The EAPCs of ASYRs in blindness and vision loss were significantly negatively correlated with the ASYRs in 1990 and positively correlated with human development indices in 2019. Conclusions: Globally, blindness and vision loss continue to cause great losses of healthy life. Reasonable resource allocation and health-service planning are needed for the prevention and early intervention of disabilities caused by vision loss.

Potential productivity loss from uncorrected and under-corrected presbyopia in low- and middle-income countries: A life table modeling study.

Objective: To estimate the burden of potential productivity losses due to uncorrected and under-corrected presbyopia in LMICs among the working-age population in both the cross-sectional and longitudinal manner. Methods: We extracted data for the prevalence of presbyopia from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019. Data for the gross domestic product (GDP) per capita were extracted from the World Bank database and Central Intelligence Agency's World Factbook. We introduced life table models to construct age cohorts (in 5-year age groups) of the working-age population (aged from 40 to 64 years old) in LMICs, with simulated follow-up until 65 years old in people with and without uncorrected presbyopia. The differences in productivity-adjusted life years (PALYs) lived and productivity between these two cohorts were calculated. The potential productivity loss was estimated based on GDP per capita. The WHO standard 3% annual discount rate was applied to all years of life and PALYs lived. Results: In 2019, there were 238.40 million (95% confidence interval [CI]: 150.92-346.78 million) uncorrected and under-corrected presbyopia cases in LMICs, resulting in 54.13 billion (current US dollars) (95% confidence interval [CI]: 34.34-79.02 billion) potential productivity losses. With simulated follow-up until retirement, those with uncorrected and under-corrected presbyopia were predicted to experience an additional loss of 155 million PALYs (an average loss of 0.7 PALYs per case), which was equivalent to a total loss of US$ 315 billion (an average loss of US$ 1453.72 per person). Conclusions: Our findings highlight the considerable productivity losses due to uncorrected and under-corrected presbyopia in LMICs, especially in a longitudinal manner. There is a great need for the development of enabling eye care policies and programs to create access to eye care services, and more healthcare investment in the correction of presbyopia in the working-age population in LMICs. This study could provide evidences for some potential health-related strategies for socio-economic development.

Comparison of the Near Eye Tool for Refractive Assessment (NETRA) and non-cycloplegic subjective refraction.

Objective: The NETRA (Near Eye Tool for Refractive Assessment) is a smartphone-based refractive tool that allows for self-evaluation of refractive error. This study investigates the validity of the NETRA with and without cycloplegia to non-cycloplegic subjective refractions (SR). Methods and analysis: Participants underwent NETRA measurements without cycloplegia, and again after the administration of cycloplegia (cyclopentolate hydrochloride 1%). Non-cycloplegic SR were also performed. Variation of refractive measurements in symmetric dioptric power space were investigated using stereo-pair comets, hypothesis tests for variances and means. Bland-Altman plots were applied to better understand validity of the NETRA against non-cycloplegic SR. Coefficients of repeatability and intraclass correlation coefficients were also determined. Results: The sample included 22 women (64.7%) and 12 men (35.3%); most were indigenous Africans (52.9%) with mean age and SD of 20.24±1.95 years. Variation of refractive measurements were mainly stigmatic (spherical), and variation of NETRA measurements decreased after cycloplegia. The pre-cycloplegia NETRA measurements (and their means) for the right and left eyes were more negative (myopic) in power than the post-cycloplegia NETRA measurements and means. On average, eyes were approximately 1.25 D more myopic with the NETRA without cycloplegia. With cycloplegia, NETRA results were in closer agreement with non-cycloplegic SR for the same eyes. Conclusion: NETRA validity to SR, even in the absence of cycloplegia, suggests the instrument may be useful in geographical regions where self-refractions might be potentially helpful in addressing limitations in eye and vision care.

Defocus curves: focusing on factors influencing assessment.

Defocus curve assessment is used to emulate defocus over a range of distances and is a valuable tool that is used to differentiate the performance of presbyopia-correcting intraocular lenses. However, defocus curves are limited by a lack of standardization, and multiple factors can affect their generation and interpretation. This review discusses key factors that influence the assessment of defocus curves, including pupil size, level of contrast, sphere vs cylinder defocus, viewing distance, monocular vs binocular assessment, use of Snellen vs logMAR charts, and diopter range and step size. Moreover, different methods to analyze defocus curves, including the direct comparison method, range-of-focus analysis, and area under the curve analysis, can affect result interpretation. A good understanding of these factors and standardization of the methodology are important to ensure optimal cross-study comparisons.

Population-based assessment of prevalence of spectacle use and effective spectacle coverage for distance vision in Andhra Pradesh, India - Akividu Visual Impairment Study.

CLINICAL RELEVANCE: Effective spectacle coverage is a useful indicator to assess the coverage of refraction services in a given region. We found a low coverage in the Akividu region suggesting a need to develop effective refraction services. BACKGROUND: To assess the prevalence of spectacle use and effective spectacle coverage for distance vision among people aged 40 years and older in the Indian state of Andhra Pradesh. METHODS: A population-based cross-sectional survey was carried out in the Akividu region in West Godavari and Krishna districts. The study teams visited selected households and conducted eye examinations in the selected clusters. A structured questionnaire was used to collect information on spectacle use. 'Met Need' was defined as unaided VA worse than 6/12 but improved to 6/12 or better with their current spectacles. 'Unmet Need' was defined as unaided VA worse than 6/12 but improved to 6/12 with pinhole, among those not using spectacles. The 'Under-met Need' was defined as aided VA worse than 6/12 but improving with pinhole to 6/12 or better. Based on these definitions, Effective Refractive Error Coverage (e-REC) is calculated as: e-REC (%) s = ((met need)/(met need + under-met need + unmet need)) X100. RESULTS: Of 3,000 enumerated from 60 clusters, 2,587 (86.2%) participants were examined. The prevalence of current spectacle use was 43.1% (95% CI:41.2-45.0). The e-REC was 37.4%. It was also lower in men compared to women and among those without any education. Participants who had cataract surgery in either eye had similar e-REC compared to those who were not operated. CONCLUSION: Though spectacle use was found to be high, there is a still large unmet need for refractive correction for distance. Effective service delivery models to provide refraction and spectacle dispensing services are needed to achieve universal eye health coverage in the region.

Quantitative assessment of photic phenomena in the presbyopia-correcting intraocular lens.

This was a prospective study to evaluate the feasibility of the photic phenomena test (PPT) for quantifying glare, halo, and starburst. We compared two presbyopia-correcting intraocular lenses (IOLs), the Symfony IOL and the PanOptix IOL, as well as the monofocal Clareon IOL in 111 IOL-implanted eyes of 111 patients who underwent the PPT 1 month postoperatively. The reproducibility of photic phenomena with the PPT was assessed in 39 multifocal IOL-implanted eyes of 20 patients and among the examiners. Patients with ocular diseases, except for refractive errors, were excluded. The mean values of the groups were evaluated. Bland-Altman plots were used to analyze statistical data (Easy R version 1.37; R Foundation for Statistical Computing, Vienna, Austria). The PPT reproducibility assessment revealed no fixed bias or regressive significance. Reproducibility was confirmed. The glare size did not differ significantly between the Symfony, PanOptix, and Clareon groups. The halo size was significantly larger in the Symfony group (p < 0.01) than in the PanOptix group. The halo intensity was significantly brighter in the PanOptix group (p < 0.01) than in the Symfony group. In contrast, no halos were perceived in the Clareon group. The starburst size or intensity did not differ significantly between the Symfony, PanOptix, and Clareon groups. We identified the photic phenomenon related to various IOLs.

Multifaceted Assessment of the Effects of an Eye Exercise for Presbyopia.

Exercise for presbyopia is theoretically ineffective. However, some studies have reported favorable subject responses, although the reasons were not detected. We investigated one such presbyopic exercise. Twenty-three volunteers (48.5 ± 5.0 years) viewed near (30-40 cm) and far (>5 m) points back and forth 20 times in one set and repeated this four times daily. After 2 months, the accommodation or near visual acuity did not improve. The pupillary size under accommodative stimulation decreased significantly (p = 0.04) from 4.03 ± 0.84 to 3.75 ± 0.98 mm, and the convergence amounts increased significantly (p = 0.03) from 0.71 ± 0.25 to 0.98 ± 0.46 mm. The overall satisfaction with the near vision improved significantly (p = 0.02). The changes in the pupillary sizes and convergence amounts did not differ between subjects with improved satisfaction (positive group) and those without improvement (negative group) (p = 0.50 and p = 0.94, respectively). The pupillary size after exercise was significantly (p = 0.04) smaller in the positive group (3.19 ± 0.82) than in the negative group (4.08 ± 0.94). In conclusion, the exercise for presbyopia was fundamentally ineffective to improve accommodation, however, it strengthened miosis while viewing near and might improve satisfaction for near vision. (Clinical Trial Registration number: UMIN000023561).

The Economic Impact of Presbyopia.

Presbyopia is the world's number one cause of vision loss with more than 1 billion individuals affected globally. The total global costs associated with correcting near vision impairment due to uncorrected presbyopia have been estimated at $30.8 billion for a comprehensive eye care model. Both cost to the patient and cost to society, which is greater in low-income countries relative to high-income areas, should be considered. Ultimately, surgical correction of the nonaccommodating dysfunctional natural lens may provide the "cure" for presbyopia. Presbyopia-correcting intraocular lenses (IOLs) may provide better visual acuity and fewer adverse effects. Patients are pursuing cataract surgery at a younger and younger age. Although this expands the viable pool for lens exchange, this younger group of patients has extreme demands and has a much more scrutinizing frame of reference for comparison (a milder cataract). Thus, they are at a much higher risk for dissatisfaction and have a much higher chance of noticing potential adverse effects from multifocal IOLs. Setting appropriate expectations and thoroughly educating patients preoperatively helps create a partnership with the patient and a strong foundation for a successful surgical outcome. A cure for presbyopia has always been considered the holy grail of ophthalmology. In 2021, ophthalmologists are moving closer to achieving this goal while also creating a safer, more productive, cost-effective solution to presbyopia on an individual and on a global level. [J Refract Surg. 2021;37(6 Suppl):S17-S19.].