Use of presbyopia-correcting intraocular lenses in patients with prior corneal refractive surgery.

PURPOSE OF REVIEW: Corneal refractive surgery has achieved spectacle-free vision for millions of patients, but this aging population is now developing cataracts. Many of these patients may wish to avoid reliance on glasses after cataract surgery. Presbyopia-correcting intraocular lenses (IOLs) offer a solution, but corneal changes after refractive surgery may compound higher order aberrations and dysphotopic symptoms associated with these IOLs. This review aims to discuss potential factors that could aid in determining suitable postkeratorefractive candidates for presbyopia-correcting IOLs. RECENT FINDINGS: Studies investigating which preoperative measures influence outcomes are lacking. The few studies that have examined presbyopia-correcting IOLs in postkeratorefractive patients report that satisfactory outcomes are possible. However, recommendations for preoperative thresholds appear limited to expert opinion and studies involving virgin corneas. SUMMARY: As the number of presbyopia-correcting IOLs and postkeratorefractive patients grows, continued investigation into relevant preoperative factors and appropriate IOLs is required to make evidence-based decisions. The current literature shows that with rigorous counseling and appropriate patient selection, presbyopia-correcting IOLs can provide postkeratorefractive patients with satisfactory results and spectacle independence. In addition, the development of postoperative modifiable IOLs may prove to be the preferred option.

[Study of the Mechanisms of Maintaining the Transparency of the Lens and Treatment of Its Related Diseases for Making Anti-cataract and/or Anti-presbyopia Drugs].

The lens of the eye is an avascular and anuclear tissue that serves to focus objects on the retina. Cataract is opacity within the clear lens that changes the transparency and refractive index of the lens causing significant visual impairments. These impairments can severely restrict the ability to carry out daily activities. Cataracts is common among elderly person occurring in more than 80% of patients aged 80 or older. Notably, we have recently identified key compounds that are effective against cataract formation. Presbyopia is also an ocular disease that typically develops in people over the age of 45 while affecting almost 100% of people over the age of 65. Recent research suggests that age-related changes in hydrostatic pressure of the lens controlled by Na/K ATPase contribute to the development of presbyopia. In the lens, Na/K ATPase has been shown to be regulated by transient receptor potential cation channels, vanilloid 1 (TRPV1) and 4, thus suggesting the potential role of TRPV1 and TRPV4 in the development of presbyopia. This review article summarizes data obtained from our laboratory with my colleagues highlighting the critical role of aquaporin 0 (AQP0) in maintaining a healthy lens redox environment, key molecules that delay the onset of cataract in vivo, as well as potential mechanisms of lens hydrostatic pressure control that may be associated with presbyopia.

Prevalence of Computer Vision Syndrome and Its Relationship with Ergonomic and Individual Factors in Presbyopic VDT Workers Using Progressive Addition Lenses.

This cross-sectional study estimated computer vision syndrome (CVS) prevalence and analysed its relationship with video display terminal (VDT) exposure, as well as sociodemographic, refractive, environmental, and ergonomic characteristics in 109 presbyopic VDT workers wearing progressive addition lenses (PALs). Usual spectacles were measured with a lens analyser, and subjective refraction was performed by an optometrist. CVS was measured with the CVS-Q©. VDT exposure was collected. Ergonomic evaluations were conducted in a normal working posture looking at the screen. Air temperature and relative humidity were measured (thermohygrometer), and illumination was measured (luxmeter). Descriptive analysis and differences in CVS prevalence, as a function of the explanatory variables, were performed (chi-square test). Multivariate logistic regression was used to identify factors associated with CVS (OR and 95% CI). The mean age was 54.0 ± 4.8 years, and 43.1% were women. The mean hours of VDT use at work was 6.5 ± 1.3 hours/day. The prevalence of CVS was 74.3%. CVS was significantly associated with women (OR 3.40; 95% CI, 1.12-10.33), non-neutral neck posture (OR 3.27; 95% CI, 1.03-10.41) and altered workplace lighting (OR 3.64; 95% CI, 1.22-10.81). Providing training and information to workers regarding the importance of adequate lighting and ergonomic postures during VDT use is advised to decrease CVS and increase workplace quality of life.

Implantation of Presbyopia-Correcting Intraocular Lenses Staged After Descemet Membrane Endothelial Keratoplasty in Patients With Fuchs Dystrophy.

PURPOSE: To assess outcomes of presbyopia-correcting intraocular lens (IOL) implantation after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy. METHODS: This retrospective single-center study evaluated a consecutive series of patients with Fuchs endothelial corneal dystrophy who received presbyopia-correcting IOLs after DMEK. The main outcomes were corrected distance visual acuity, uncorrected distance visual acuity, uncorrected near visual acuity, and refractive error. RESULTS: Fourteen extended depth of focus and 2 bifocal IOLs were implanted in 16 eyes of 8 patients (5 women and 3 men; age, 47-68 years). Fourteen IOLs were spherical and 2 were toric. Postoperatively, the median corrected distance visual acuity was 20/20 (range, 20/15-20/25), the median binocular uncorrected distance visual acuity was 20/25 (range, 20/15-20/25), the median binocular uncorrected near visual acuity was 20/20 (range, 20/20-20/50), and the median manifest spherical equivalent refraction was 0.05 diopters (D) (range, -0.75 to +0.75 D). Implantation of toric extended depth of focus lenses reduced refractive cylinder from 1 and 2.25 D preoperatively to 0 D in both eyes of 1 patient postoperatively. A comparison of biometry measurements taken before and after DMEK showed the median change in average keratometry was 0.26 D with a substantial range of -1.74 to +1.18 D. The median endothelial cell loss was 63 cells/mm (3%) after staged phacoemulsification. CONCLUSIONS: Favorable visual and refractive outcomes were obtained with presbyopia-correcting IOLs in patients with Fuchs dystrophy when the biometry measurements and IOL implantation were staged after DMEK had cleared the guttae and corneal edema.

Presbyopia and the aging eye: Existing refractive approaches and their potential impact on dry eye signs and symptoms.

Every part of the human body is subject to aging, including the eye. An increased prevalence of dry eye disease with age is widely acknowledged. Aging threatens ocular surface homeostasis, altering the normal functioning of the lacrimal functional unit and potentially leading to signs and symptoms of dry eye. Additional age-related processes take place within the crystalline lens, leading to presbyopia and cataractogenesis. Correction strategies for presbyopia and cataracts may directly or indirectly challenge the ocular surface. Contact lenses disturb the normal structure of the tear film and can interact negatively with the ocular surface, further deteriorating an already unbalanced tear film in presbyopes, however, newer contact lens designs can overcome some of these issues. Moreover, cataract and corneal refractive surgeries sever corneal nerves and disrupt the corneal epithelium and ocular surface, which can influence surgical outcomes and aggravate dryness symptoms in older age groups. This review summarises the current understanding of how the invasive nature of contact lens wear and cataract and refractive surgery influence signs and symptoms of ocular dryness in an aging population.

Outcomes of presbyopia-correcting intraocular lenses after laser in situ keratomileusis.

BACKGROUND: Laser in situ keratomileusis (LASIK) is the most common refractive surgery in young patients, which aims at providing a clear distance vision without the use of spectacles. With time, these patients develop symptomatic cataract, which affects activities of daily living, and to improve visual acuity, intraocular lens (IOL) implantation can be considered. In post-myopic LASIK patients, to allow continuation of spectacle independence, the implantation of presbyopia-correcting IOLs is a suitable option. The purpose of this retrospective case series is to report the visual outcome and quality in post-myopic LASIK eyes after the implantation of AT LISA tri839MP IOL. METHOD: Twenty eyes of 13 patients with history of myopic LASIK within 20 years underwent phacoemulsification by one single surgeon. All eyes were implanted with AT LISA tri839PMP IOL, and their outcomes were evaluated at 6 months postoperation. RESULTS: The mean postoperative uncorrected distance visual acuity (VA) is 0.28 ± 0.29, while the corrected distance VA is 0.06 ± 0.14. The mean postoperative uncorrected near VA is 0.02 ± 0.05, while the corrected near VA is 0.01 ± 0.02. The mean postoperative manifest refraction spherical equivalent (SE) is - 0.92 ± 0.76D. There is a statistically significant difference between the preoperative and postoperative refraction (p = 0.02), which shows a postoperative myopic shift. There is also a statistically significant difference between the mean targeted SE and postoperative manifest refraction SE (p = 0.00). Only one out of 20 eyes (5%) reported halo and glare symptoms. Ten out of 20 eyes (50%) are able to achieve spectacles independence. CONCLUSION: In conclusion, in post-myopic LASIK eyes, AT LISA tri839MP provides a good visual outcome at both near and distance, but is more predictable at near than at distance. There is a myopic shift in the postoperative SE. Visual quality is satisfactory and has not been exacerbated. Most patients can remain to be spectacles free at all distances.

Optimizing outcomes with multifocal intraocular lenses.

Modern day cataract surgery is evolving from a visual restorative to a refractive procedure. The advent of multifocal intraocular lenses (MFIOLs) allows greater spectacle independence and increased quality of life postoperatively. Since the inception in 1980s, MFIOLs have undergone various technical advancements including trifocal and extended depth of vision implants more recently. A thorough preoperative workup including the patients' visual needs and inherent ocular anatomy allows us to achieve superior outcomes. This review offers a comprehensive overview of the various types of MFIOLs and principles of optimizing outcomes through a comprehensive preoperative screening and management of postoperative complications.

Long-sightedness in old wild bonobos during grooming.

Some scientists have suggested that, among Hominidae, prolonged postmenopausal longevity evolved uniquely in humans [1], while others disagree [2]. There have, however, been few empirical studies on how physiological aging and somatic durability in humans compare to our closest relatives - chimpanzees and bonobos [3]. If prolonged lifespan is selected for in humans, physiological aging, including reproductive and somatic senescence, might be different for Pan and Homo. But it seems that the parameters of reproductive senescence, such as the age of having their final offspring and the number of years between generations, are not very different between chimpanzee and human females [4]. Here, we report evidence for five cases of long-sightedness (presbyopia) in old wild bonobos, exhibited during grooming. Our results suggest that senescence of the eye has not changed much since the divergence of Pan and Homo from their common ancestor.

Computer vision syndrome in presbyopia and beginning presbyopia: effects of spectacle lens type.

PURPOSE: This office field study investigated the effects of different types of spectacle lenses habitually worn by computer users with presbyopia and in the beginning stages of presbyopia. Computer vision syndrome was assessed through reported complaints and ergonomic conditions. METHODS: A questionnaire regarding the type of habitually worn near-vision lenses at the workplace, visual conditions and the levels of different types of complaints was administered to 175 participants aged 35 years and older (mean ± SD: 52.0 ± 6.7 years). Statistical factor analysis identified five specific aspects of the complaints. Workplace conditions were analysed based on photographs taken in typical working conditions. RESULTS: In the subgroup of 25 users between the ages of 36 and 57 years (mean 44 ± 5 years), who wore distance-vision lenses and performed more demanding occupational tasks, the reported extents of 'ocular strain', 'musculoskeletal strain' and 'headache' increased with the daily duration of computer work and explained up to 44 per cent of the variance (rs = 0.66). In the other subgroups, this effect was smaller, while in the complete sample (n = 175), this correlation was approximately rs = 0.2. The subgroup of 85 general-purpose progressive lens users (mean age 54 years) adopted head inclinations that were approximately seven degrees more elevated than those of the subgroups with single vision lenses. CONCLUSIONS: The present questionnaire was able to assess the complaints of computer users depending on the type of spectacle lenses worn. A missing near-vision addition among participants in the early stages of presbyopia was identified as a risk factor for complaints among those with longer daily durations of demanding computer work.

Disorders of Accommodative Convergation and Accommodation (AC/A) Relations at Traumatic Brain Injury.

INTRODUCTION: Accommodative Convergence/Accommodation (AC/A) ratio is constant at one and the same person in the course of life, i.e. the same ratio accommodative convergence monitor any change in accommodation measured in diopters. Such a perfect relationship is possible if there are no refractive anomalies in both eyes and oculomotor imbalance of eye muscles. MATERIAL AND METHODS: We are examined 50 patients with close brain injury, and patients which had problems with near vision, accommodation and convergency were reducted, with loss motor fussion, and preserved stereoscopis vision, and showed us, that disturbances are clear motor and folowed with incapable of patient to hold of superposition view to watching object. RESULTS: The difference in average proximity distance vision and reading time with no fatigue after 6 months a statistically significant, the value of t-test, t = 1873 for p <0.01, r = 0. 718. The value of convergent fusion 6 months after treatment in 30% of the patients was from 0 to16 Pd, S. D. = 18. 6, and χ(2) = 7. 22. In 18% of the patients was from 0 to 10 Pd, S. D = 17. 61, and χ(2) = 5. 41, at 20% of patients 0 to 22 Pd, SD = 14. 18, χ(2) = 6. 84, in 16% of patients 0 to 4 Pd, SD = 16. 41, χ(2) t-test = 5. 13 and the remaining 16% of patients the value of convergent fusion is about 1 PD, S. D = 15. 01, χ(2) t = 5. 18. All patients showed significant improvement in near vision compared to the value of convergent fusion before treatment where χ(2) t-test = 9.41, after 6 months of treatment, there is considerable significance p < 0 01, t-test 0. 914, correlation coefficient r = 0. 881. CONCLUSION: Disturbances of AC / A ratio should be evaluated only with regard to all symptoms and is only possible by proper rating interference in reading.

[Research Progress in Measurement of Human Accommodative Amplitude].

Accommodation is an important function of the human eye, which can change the parameters of ocular refractive system and also has a strong correlation with the development of myopia and presbyopia. Several subjective measurements have been applied in accommodation assessment such as push-up test, push-down test and minus-lens procedures. It can be measured objectively by measuring the change in refraction of the eye with dynamic retinoscopy or autorefractor. This article reviews the application of measurement of accommodative amplitude and research progress in accommodation, providing clinical information for further studies.

[Clinical results of a multifocal pseudophakic additional lens]. / Klinische Ergebnisse einer multifokalen pseudophaken Zusatzlinse.

BACKGROUND: In order to meet the patients wish for compensation of presbyopia in a flexible way, even in cases of an already pseudophacic eye, sulcus-fixated additional intraocular lenses (IOL) have been developed as an alternative to multifocal IOLs (MIOL) in the capsular bag. This allows subsequent application of multifocal optics. Furthermore, these additional lenses offer a relatively simple opportunity for postoperative refractive fine tuning or, in cases of incompatibility, a minimally invasive explantation of the multifocal part of the optical system. PURPOSE: The objective of our work was the examination of a diffractive multifocal additional IOL and its functional characteristics. MATERIAL AND METHODS: In a prospective, monocentric trial 32 eyes of 21 patients had cataract surgery with implantation of a monofocal IOL into the capsular bag and simultaneous implantation of a multifocal additional IOL into the sulcus. The visual acuity was tested at different distances 6 weeks and 3 months postoperatively. At the 3 month follow-up contrast sensitivity and defocus curves were additionally assessed. Patients with bilateral implantation filled in a questionnaire to assess their subjective satisfaction of postoperative visual quality. RESULTS: All eyes had an uneventful postoperative course. At both follow-ups an uncorrected distance and near visual acuity (VA) of 0.2 LogMAR or better was achieved. In intermediate vision 29 out of 32 eyes after 6 weeks and 31 out of 32 eyes after 3 months reached an uncorrected VA of 0.2 LogMAR or better. The defocus curves showed a typical two-peaked shape. At intermediate distance (-1.5 D of defocus) the median VA was 0.35 LogMAR. Contrast sensitivity testing showed results in the upper region of the standard range of age-matched, healthy patients. DISCUSSION: The examined type of diffractive additional IOL achieved good to very good functional results, which are comparable to corresponding IOLs in the capsular bag. Multifocal additional IOLs can be considered as a useful extension of refractive surgical alternatives for the compensation of presbyopia. The possibility to implant the multifocal optic part independently of the primary surgery, the minimal invasivity of the procedure and the likewise time-independent reversibility can be pointed out as special qualities of these IOL.

Apparent progression of presbyopia after laser in situ keratomileusis in patients with early presbyopia.

PURPOSE: To assess the effect of laser in situ keratomileusis (LASIK) on near visual function in presbyopic patients. DESIGN: Retrospective cohort study. METHODS: Fifty-three eyes of 40 patients 45 years of age and older who had undergone LASIK for high myopia (-6 diopters [D] and over) were included. The minimal add powers for obtaining the best-corrected near visual acuity (add powers) were measured preoperatively and 3 months postoperatively, and the correlations with the powers corrected by LASIK, corneal higher-order aberrations (HOAs), ocular HOAs, and patient ages were evaluated using univariate analysis. Factors correlated with the changes in add powers were evaluated further by multivariate analysis. RESULTS: The mean ± standard deviation patient age was 50.0 ± 4.1 years; the power corrected by LASIK was -7.56 ± 1.06 D. The mean add power was 1.80 ± 0.60 D preoperatively, which increased significantly (P < .001) to 2.18 ± 0.69 D postoperatively. Significant correlations with the increased add powers were detected with age (P = .01) and the power corrected by LASIK (P = .04) but not with corneal and ocular HOAs (P > .05). Multivariate analysis showed that only age was correlated significantly (P = .01). The percentage of eyes with increased add powers of 0.5 D or more was 60.4%, which was significantly (P = .02) higher in younger patients. CONCLUSIONS: This study verified the apparent progression of presbyopia after LASIK and the importance of obtaining informed consent from patients, especially those with early presbyopia.

Presbyopia: Prevalence; Distribution and Determinants in Owerri; Nigeria

Background: Presbyopia causes blurring and impairment of vision at near. It is the most common physiologic change in the adult eye with advancing age. Good near vision is a necessity for domestic activities; office work and near vision tasks other than reading and writing; especially among adults in a resource-limited economy. The study determined the prevalence; distribution and determinants of presbyopia; presbyopic spectacle coverage; and provided data for ready-made near vision spectacles in Imo State; Nigeria. Materials and Methods: A total of three thousand; four hundred and fifty-one adults consisting of 2606 persons as study group and 845 persons as controls were randomly selected for the study. Structured questionnaire was administered to the subjects. Their visual acuity at far and near including tonometry; ophthalmoscopy; perimetry; retinoscopy and subjective refraction were done. Subjects who could not read N6 and emmetropes; who are 40 years and above were considered as presbyopic. Results: The prevalence of presbyopia was 70.9 and 75.0 of study and control groups respectively. Females aged 40-49 were in the majority (57.1 and 51.9 of females in the study and control groups respectively). Subjects requiring additions at near of ?+1.50DS to 2.00DS were in the majority (39.0 and 46.4 of study and control groups respectively). Amongst the presbyopes 61.3 and 78.7 of study and control groups respectively did not have presbyopic correction. The subjects were also ignorant of corneal inlay technology in treatment of presbyopia. A higher prevalence exists among rural dwellers and the contributory factors were environmental influences; poor nutrition and irrational use of chloroquine for treatment of malaria. Conclusion: Over seventy-percent of presbyopia was found in this study. The determinants were age; gender; nutrition and drug use. Majority of the presbyopes were domicile in the rural area and did not have corrective spectacles. We recommend visual health education; regular vision screening and intervention to achieve the targets of vision 2020 in low-and-medium-income countries

Bilateral implantation of toric multifocal additive intraocular lenses in pseudophakic eyes.

UNLABELLED: A 41-year-old patient presented with hyperopia, astigmatism, and presbyopia for refractive treatment 6 years following cataract surgery. A toric multifocal additive intraocular lens with a near addition of +3.5 diopters (D) for sulcus implantation was chosen and implanted uneventfully. Follow-up examinations were performed from the first day until 9 months after surgery. A predictable refractive correction was seen, with a residual error of +0.125 D (spherical equivalent) in the right eye and emmetropia in the left eye. Monocular uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) (40 cm) improved to 0.1 logMAR. It could not be improved further with near-add spectacles. Binocular UDVA and UNVA were 0.0 logMAR and 0.1 logMAR (80 cm), respectively. Both additive IOLs remained centered and on axis during the follow-up period. Spectacle independence was achieved, as was high patient satisfaction. FINANCIAL DISCLOSURE: The International Vision Correction Research Centre received research grants related to this publication from the following companies: Dr. Schmidt Intraocularlinsen GmbH, Rayner Intraocular Lenses, Ltd., and Carl Zeiss Meditec AG. No author has a financial or proprietary interest in any material or method mentioned.

Axial length and proliferative diabetic retinopathy.

PURPOSE: To determine the correlation between axial length and diabetic retinopathy (DR) in patients with diabetes mellitus for 10 years or more. METHODS: This study was a prospective, observational, cross-sectional study. Patients with diabetes for 10 years or more were included. We excluded eyes with any other significant ocular disease or any prior intraocular surgery, except uncomplicated cataract surgery. Only one eye of each patient was included as the study eye. The severity of DR was graded as no DR, non-proliferative DR (NPDR), or proliferative DR (PDR). Axial length was measured by A-scan ultrasound (10 MHz Transducer, AL-2000 Biometer/Pachymeter; Tomey, Phoenix, AZ). Univariate logistic regression models were used to evaluate the relationship between the dependent variables (any DR, PDR) and all potential risk factors. Axial length and other factors with p value <0.1 were included in multivariate logistic regression models. Backward selection based on the likelihood ratio statistic was used to select the final models. RESULTS: We included 166 eyes from 166 patients (93 female and 73 male; mean age, 68.8 years). The mean diabetes duration was 15.4 years. Fifty-four (32.5%) eyes had no DR, 72 (43.4%) eyes had NPDR, and 40 (24.1%) eyes had PDR. In univariate analysis, hypertension (p = 0.009), renal impairment (p = 0.079), and insulin use (p = 0.009) were associated with developing any DR. Hypertension (p = 0.042), renal impairment (p = 0.014), insulin use (p = 0.040), pseudophakia (p = 0.019), and axial length (p = 0.076) were associated with developing PDR. In multivariate analysis, hypertension (p = 0.005) and insulin use (p = 0.010) were associated with developing any DR. Hypertension (p = 0.020), renal impairment (p = 0.025), pseudophakia (p = 0.006), and axial length (p = 0.024) were associated with developing PDR. CONCLUSIONS: This observational study suggests an inverse relationship between axial length and the development of PDR in patients with diabetes for 10 years or more. No relationship was found between axial length and the development of any DR.