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Current management of presbyopia.

Papadopoulos PA, Papadopoulos AP - Middle East Afr J Ophthalmol (2014 Jan-Mar)

Bottom Line: Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life.Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability.The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmology Clinic, Athens Metropolitan Hospital, Athens, Greece ; Ophthalmology Department, Slovak Medical University, Bratislava, Slovakia.

ABSTRACT
Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life. The correction of presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability. There are however, a number of limitations and considerations that have prevented widespread acceptance of surgical correction for presbyopia. The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery. The purpose of this paper is to provide an update of current procedures available for presbyopia correction and their limitations.

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Diffractive Apodized Multifocal IOL
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Figure 2: Diffractive Apodized Multifocal IOL

Mentions: The multifocality of the latest generation IOLs is based on refractive and diffractive technology. Excellent clinical outcomes have been reported with different IOLs.616263 Patient selection is very crucial in order to avoid patient dissatisfaction and secondary procedures for IOL exchange. Until recently, most multifocal IOLs could provide satisfactory vision for far and either near or intermediate distance [Figure 2]. They were actually bifocal lenses. The most recent multifocal IOLs with improved optics have enhanced intermediate distance, giving the patient a full range of vision.6465 Multifocal IOLs reduce contrast sensitivity and cause more glare and halos in comparison to monofocal IOLs.66 In some cases, these optical phenomena can be disturbing and a secondary intervention and IOL explantation might be required.67 A study by Mamalis et al. on IOLs requiring explantation, the second most frequently explanted IOL was the multifocal hydrophobic acrylic IOL (23%). The most common reason for explantation or secondary intervention was glare/optical aberrations (68%), followed by incorrect IOL power (21%). Precise biometry for IOL calculation and correction of astigmatism is crucial for a good outcome after multifocal IOL implantation. Corneal astigmatism reduced through-focus image quality and depth of focus with all IOLs evaluated in a study by Zheleznyak et al.68 However, the multifocal IOLs had the most severe decline in depth of focus. In eyes with astigmatism of 0.75 D and above, a toric multifocal IOL provides better quality of vision in all distances. In cases where a multifocal IOL is not indicated, monovision can been used to provide near, intermediate, and distance vision and is one of the most common methods used in cataract patients to correct presbyopia.59


Current management of presbyopia.

Papadopoulos PA, Papadopoulos AP - Middle East Afr J Ophthalmol (2014 Jan-Mar)

Diffractive Apodized Multifocal IOL
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959035&req=5

Figure 2: Diffractive Apodized Multifocal IOL
Mentions: The multifocality of the latest generation IOLs is based on refractive and diffractive technology. Excellent clinical outcomes have been reported with different IOLs.616263 Patient selection is very crucial in order to avoid patient dissatisfaction and secondary procedures for IOL exchange. Until recently, most multifocal IOLs could provide satisfactory vision for far and either near or intermediate distance [Figure 2]. They were actually bifocal lenses. The most recent multifocal IOLs with improved optics have enhanced intermediate distance, giving the patient a full range of vision.6465 Multifocal IOLs reduce contrast sensitivity and cause more glare and halos in comparison to monofocal IOLs.66 In some cases, these optical phenomena can be disturbing and a secondary intervention and IOL explantation might be required.67 A study by Mamalis et al. on IOLs requiring explantation, the second most frequently explanted IOL was the multifocal hydrophobic acrylic IOL (23%). The most common reason for explantation or secondary intervention was glare/optical aberrations (68%), followed by incorrect IOL power (21%). Precise biometry for IOL calculation and correction of astigmatism is crucial for a good outcome after multifocal IOL implantation. Corneal astigmatism reduced through-focus image quality and depth of focus with all IOLs evaluated in a study by Zheleznyak et al.68 However, the multifocal IOLs had the most severe decline in depth of focus. In eyes with astigmatism of 0.75 D and above, a toric multifocal IOL provides better quality of vision in all distances. In cases where a multifocal IOL is not indicated, monovision can been used to provide near, intermediate, and distance vision and is one of the most common methods used in cataract patients to correct presbyopia.59

Bottom Line: Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life.Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability.The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery.

View Article: PubMed Central - PubMed

Affiliation: Ophthalmology Clinic, Athens Metropolitan Hospital, Athens, Greece ; Ophthalmology Department, Slovak Medical University, Bratislava, Slovakia.

ABSTRACT
Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life. The correction of presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability. There are however, a number of limitations and considerations that have prevented widespread acceptance of surgical correction for presbyopia. The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery. The purpose of this paper is to provide an update of current procedures available for presbyopia correction and their limitations.

Show MeSH
Related in: MedlinePlus