A systematic review of pseudophakic monovision for presbyopia correction

A systematic review of the recent literature regarding pseudophakic monovision as a reliable methods for presbyopia correction was performed based on the PubMed, MEDLINE, Nature and the American Academy of Ophthalmology databases in July 2015 and data from 18 descriptive and 12 comparative studies were included in this narrative review. Pseudophakic monosvision seems to be an effective method for presbyopia with high rates of spectacles independence and minimal dysphotopsia side- effects, that should be considered by the modern cataract surgeons.

Refractive outcomes and optical quality of PRESBYOND laser-blended vision for presbyopia correction

AIM: To investigate the one-year refractive outcomes and optical quality following PRESBYOND laser-blended vision(LBV).METHODS: This retrospective study included 20 patients who underwent PRESBYOND treatment between Jan 2019 and Aug 2020. The patients were asked to attend a followup outpatient visit one year after surgery. Distance and near visual acuity as well as subjective refraction were examined. Optical quality was assessed using wavefront-supported custom ablation. A questionnaire evaluating optical quality and satisfaction was completed at the last visit.RESULTS: The average patient age was 48.1±7.4 y(range, 41 to 58 y). The mean preoperative spherical equivalent was-7.59±2.39D. At the one-year follow-up, two eyes(both dominant eyes) lost one line of corrected distance visual acuity(CDVA), while the remaining eyes(38/40) maintained or gained lines of CDVA. The average binocular uncorrected distance visual acuity improved from 0.15±0.03 to 0.90±0.26(decimal vision;P<0.001). The average binocular uncorrected near visual acuity increased from 0.34±0.28 to 0.97±0.07(P<0.001). The spherical aberration was 0.04±0.06 μm in the nondominant eye and 0.09±0.09 μm in the dominant eye(P=0.02). All patients were satisfied with or accepted the outcomes of the surgery. The primary complaints were related to disturbances in night vision and relatively inferior near vision.CONCLUSION: Over the one-year observation period, PRESBYOND is a safe and effective option for presbyopia correction. The optical quality and near vision deserve further investigation.

One year results of presbyLASIK using hybrid bi-aspheric micro-monovision ablation profile in correction of presbyopia and myopic astigmatism

●AIM:To analyze one year clinical outcomes and subjective rating of hybrid bi-aspheric multifocal central presbyLASIK with micro-monovision for correction of presbyopia and myopic astigmatism.●METHODS:Seventy-four eyes of 37 patients consecutively treated with presbyLASIK were assessed.The mean age of the patients was 43.8±3.0 y with a mean spherical equivalent refraction of-5.21±1.87 diopters(D)and mean astigmatism of-0.82±0.64 D.Visual acuity,manifest refraction,contrast sensitivity,aberrometry and patients’subjective rating were evaluated pre-and postoperatively.●RESULTS:At 1 y postoperatively(68 eyes of 34 patients),the mean spherical equivalent(SE)refraction in distance eyes was 0.06±0.05 D,whereas the achieved SE in near eyes was-0.83±0.05 D.Ninety-nine percent of eyes were within±0.50 D of target correction of SE.The binocular mean uncorrected distance visual acuity(UDVA)was 0.00±0.18 logMAR(20/20).Sixty-four percent of patients achieved 0.0 logMAR(20/20)or better of UDVA and 0.1 logRAD or better of UNVA as well.There was a binocularly loss of one line CDVA after surgery for only one patient(3%,1/34)and no patient lost 2 lines.The changes in binocular contrast sensitivity(CS)in all test conditions were not significant at any frequency after surgery.The changes of entire eye total higher order aberrations(tHOA)and spherical aberrations(SA)significantly higher in near eyes than in distance eyes.The overall satisfaction score for surgery was 93±8.●CONCLUSION:The hybrid bi-aspheric multifocal central presby LASIK with micro-monovision appears to be an efficacious option for myopic presbyopes.One year postoperative outcomes in a relatively young presbyopia population indicate improvements in both far and near vision with high satisfaction.

Clinical performance of presbyopia correction with a multifocal corneoscleral lens

AIM:To assess the clinical performance of a multifocal corneoscleral lens for the presbyopia correction.METHODS:A prospective clinical trial of the OnefitTM A multifocal corneoscleral lens was conducted with 40 participants with presbyopia.At 4 wk of continuous wear of the corneoscleral lens,changes in the distance,intermediate,and near visual acuity(VA)were evaluated.The safety of the corneoscleral lens,central corneal thickness(CCT),corneal endothelial cell count,binocular stereopsis,tear film break-up time(BUT),corneal staining,corneal edema,corneal neovascularization(NV),and conjunctival hyperemia were examined.In addition,a subjective questionnaire addressing satisfaction(rated from 1 to 5 points)and discomfort(rated from 1 to 5 points)was administered.RESULTS:Forty participants were enrolled in this study.Six participants were excluded because of poor compliance with lens fitting(n=2)and loss to follow-up(n=4).The mean age of the participants was 53.0±4.9 y.At 4 wk of continuous wear of the corneoscleral lens,the best corrected far,intermediate,and near VA was 0.08±0.11,0.10±0.12,and 0.10±0.12 log MAR,respectively.These results were significant improvements over the baseline uncorrected VA(far:P=0.004;intermediate:P=0.004;near:P=0.002).CCT,corneal endothelial cell count,binocular stereopsis,BUT,corneal staining,corneal edema,corneal NV,and conjunctival hyperemia were not significantly different between baseline and after corneoscleral lens use.The average satisfaction scores for fit sensation;corrected far,intermediate,and near VA;and ease of handling were 4.1,3.4,3.6,3.5,and 3.4,respectively.The average discomfort scores for dryness,irritation,foreign body sensation,redness,fogging,and halo were 1.7,1.8,1.5,1.7,1.7,and 1.3,respectively.CONCLUSION:Far,intermediate,and near VA are improved in presbyopic patients with the multifocal corneoscleral lens compared to uncorrected baseline VA,without adverse ocular effects.This evidence supports the safety and effectiveness of presbyopia correction with multifocal corneoscleral lenses.

Scleral surgery for the treatment of presbyopia: where are we today?

Presbyopia corrections traditionally have been approached with attempts to exchange power,either at the cornea or the lens planes,inducing multifocality,or altering asphericity to impact the optical system.Treatments that affect the visual axis,such as spectacle and contact lens correction,refractive surgeries,corneal onlays and inlays,and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye.Their aim is instead to enhance‘pseudoaccommodation’by facilitating an extended depth-of-focus for which vision is sufficient.There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution,rather than a‘vision correction’solution that compromises other components of the optical system.Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia.While the theoretical justification of scleral surgical procedures remains controversial,there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia.Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s,and this remains an active area of research.In this article,we discuss the historic scleral surgical procedures,the two scleral procedures currently available,as well as an outlook of the future for the scleral surgical space for treating presbyopia.

Pattern of Eye Diseases among Tea Workers

Background: Bangladesh’s tea industry is essential to the country’s economic expansion. Since tea workers in Bangladesh are marginalized within our community, they have limited access to comprehensive eye care services. Productivity and well-being are cornerstones of comprehensive health care strategy. Ocular disorders are influenced by life expectancy, sociodemographic status, and the epidemiological transition. In this context, the state of ocular health and the many eye illnesses remain to be significantly addressed. Purpose: To evaluate the pattern of eye diseases among tea workers in a tea estate of Bangladesh. Methods: This cross-sectional observational study was carried out in Halda Valley Tea Estate, Nazirhat, Fatickchari, Chattogram, Bangladesh, under the supervision of the Department of Community Ophthalmology, BSMMU, following ethical clearance and approval by the IRB board of BSMMU. With informed written consent and approval from the authority of the tea estate, a total of 110 tea workers were recruited. Socio-demographic characteristics, ocular findings, and patterns of eye diseases were determined and recorded. Results: The mean age of the study participants was 39.60 ± 11.63 years. The maximum (58.1%) study participants were 31 - 50 years old, female (64.5%), illiterate (82.7%), and tribal (71.8%) indigenes. Eye diseases were found in 94.5% of workers. Presbyopia (28.2%), cataracts (27.3%), and refractive error (26.4%) were the most common. Tea workers with eye diseases were significantly older than those who did not have any eye diseases (40.20 ± 11.57 vs. 29.17 ± 7.31 years, p Conclusion: A significant number of tea workers had eye diseases, of which presbyopia, cataracts, and refractive error were the most common.

双眼不同人工晶状体混搭植入矫正老视的临床效果评价

近年来,功能性人工晶状体(IOL)的应用为白内障患者视觉质量的改善提供了有效选择,术后满意度及脱镜率高,但也存在眩光、立体视损害等不良现象。匹配应用两种不同的IOL进行植入,发挥IOL各自的优点以提供更卓越的术后效果已被越来越多的眼科医师重视,探索更优化的IOL植入方案是治疗白内障同时矫治老视的重要课题。本文就IOL混搭植入在治疗白内障同时矫正老视的研究进展进行综述。

“运目操”对老视干预作用的临床观察

目的观察“运目操”对老视的干预作用。方法纳入2021年3月—2021年10月于中国中医科学院眼科医院就诊的老视患者61例(61只眼),随机分为治疗组30例(30只眼)和对照组31例(31只眼)。分别予“运目操”疗法和健康宣教。2组均观察8周。分别于治疗前、后测量患者的视近屈光度、调节近点、阅读速度和阅读视力、调制传递函数(modulation transfer function,MTF)截止频率和平均散射指数(mean object scatter index,Mean OSI)、主观症状评分。结果2组治疗前视近屈光度、调节近点、阅读视力、阅读速度、MTF截止频率、Mean OSI及主观症状评分比较,差异均无统计学意义(P>0.05)。(1)视近屈光度:2组治疗后视近屈光度较治疗前比较,及治疗后2组间比较,差异均无统计学意义(P>0.05)。(2)调节近点:治疗组治疗后调节近点较治疗前减小,差异有统计学意义(t=7.581,P=0.000);对照组调节近点较治疗前比较,及治疗后2组间比较,差异均无统计学意义(P>0.05)。(3)阅读速度和阅读视力:治疗后治疗组阅读速度提高比较,差异统计学意义(t=-2.273,P=0.031);对照组阅读速度较治疗前比较,及治疗后2组间比较,差异均无统计学意义(P>0.05)。治疗组治疗后阅读视力较治疗前提高,差异有统计学意义(Z=-3.669,P=0.000);对照组阅读视力较治疗前比较,差异无统计学意义(P>0.05)。治疗后2组间比较,治疗组优于对照组,差异有统计学意义(Z=-1.894,P=0.047)。(4)Mean OSI和MTF截止频率:对照组治疗后Mean OSI值较治疗前增大,差异有统计学意义(Z=-2.884,P=0.004),而治疗组Mean OSI值较治疗前,差异无统计学意义(P>0.05);治疗后2组间比较,治疗组优于对照组,差异有统计学意义(Z=-2.835,P=0.005)。对照组治疗后MTF截止频率较治疗前减小,差异有统计学差异(t=4.439,P=0.000),而治疗组MTF截止频率较治疗前,差异无统计学意义(P>0.05);治疗后2组间比较,治疗组高于对照组,差异有统计学意义(t=3.019,P=0.004)。(5)主观症状积分:治疗组治疗后主观症状评分较治疗前减小,差异有统计学意义(t=7.607,P=0.000),而对照组较治疗前,差异无统计学意义(P>0.05);治疗后2组间比较,治疗组低于对照组,差异有统计学意义(t=-2.527,P=0.014)。(6)临床疗效:治疗组有效率为13.33%,对照组为9.68%,差异无统计学意义(P>0.05)。结论“运目操”可不同程度地改善老视患者的阅读视力、阅读速度、调节近点及阅读疲劳、眼部酸痛和久视头晕等主观症状,可作为老视的一项干预措施予以推广。

老视发病机制及防治方法的研究进展

老视是一种随着年龄增长,眼晶状体的弹性和可塑性下降,睫状肌功能变弱,导致近距离工作和阅读发生困难、视物不能持久、易出现视疲劳的疾病。本文对老视的发病机制及防治方法进行综述,发现影响老视的因素主要有年龄、性别、疾病和药物等,治疗方法主要包括光学矫正、手术和药物治疗,均可在一定程度上改善老视的视近困难。目前,光学矫正是最常见治疗方法,矫治手术分为角膜手术、晶状体手术和巩膜手术,均存在着一定的限制和风险。药物治疗包括缩瞳类药物、恢复晶状体弹性药物以及中药,但多处于研究阶段。本研究通过对老视发病机制及防治方法的总结,可为未来的临床研究及治疗提供思路。

新无极与多焦晶体植入治疗白内障合并散光、老视临床疗效的比较分析

目的比较白内障合并散光、老视患者白内障超声乳化术中应用新无极与多焦晶体植入效果。方法103例(115眼)白内障合并散光、老视患者均行白内障超声乳化术,将其分为新无极组(54例62眼)与多焦组(49例53眼)。比较两组患者手术前后视力以及术后对比敏感度、全眼波前像差、术后满意度、脱镜率、不良视觉现象、术后并发症。结果两组患者术后视力较术前改善(P<0.05),新无极组患者术后近视力低于多焦组,中视力高于多焦组(P<0.05);新无极组患者暗环境在不同空间频率下对比敏感度高于多焦组(P<0.05);新无极组患者总像差、总高阶像差、三叶草、彗差等全眼波前像差低于多焦组(P<0.05);新无极组近距离视物满意度评分低于多焦组,中距离视物、流畅阅读、夜间视物满意度评分高于多焦组(P<0.05);新无极组星芒感、光晕感、眩光感不良视觉现象发生率低于多焦组(P<0.05)。两组并发症比较差异无显著性(P>0.05)。结论应用新无极晶体以及多焦晶体均可有效改善患者视力,新无极晶体在中视力改善上更具优势,多焦晶体对于近视力改善优势更显著。

Clinical outcomes of combined versus separate carbachol and brimonidine drops in correcting presbyopia

Background:To test and compare in a masked fashion the efficacy of using a parasympathomimetic drug(3%carbachol)and an alpha-2 agonist(0.2%brimonidine)in both combined and separate forms to create optically beneficial miosis to pharmacologically improve vision in presbyopia.Methods:A prospective,double-masked,randomized,controlled clinical trial was conducted.Ten naturally emmetropic and presbyopic subjects between 42 and 58 years old with uncorrected distance visual acuity of at least 20/20 in both eyes without additional ocular pathology were eligible for inclusion.All subjects received 3%carbachol and 0.2%brimonidine in both combined and separate forms,3%carbachol alone and 0.2%brimonidine(control)alone in their non-dominant eye in a crossover manner with one week washout between tests.The subjects’pupil sizes and both near and distance visual acuities will be evaluated pre-and post-treatment at 1,2,4,and 8 h,by a masked examiner at the same room illumination.Results:Statistically significant improvement in mean near visual acuity(NVA)was achieved in all subjects who received combined 3%carbachol and 0.2% brimonidine in the same formula compared with those who received separate forms or carbachol alone or brimonidine alone(P<0.0001).Conclusion:Based on the data,the combined solution demonstrated greater efficacy than the other solutions that were tested.Improving the depth of focus by making the pupil small caused statistically significant improvement in near visual acuity,with no change in binocular distance vision.Trial registration:ACTRN12616001565437.Registered 11 November 2016.

老视发生及与症状相关的因素研究

老视是一种与年龄相关的生理现象,主要表现为人眼调节能力下降引起的渐进性视近障碍。老视的发病会显著降低生活质量,且在世界范围内,人口的老龄化使得老视的患病率不断攀升,故这已成为一个备受关注的全球性问题。目前认为,年龄是老视发生的主要原因,但不少研究发现外界及自身其他条件的改变也会对老视的发生、发展产生一定作用。本文将就有关因素对老视发生和症状严重程度的影响及其最新研究进展进行逐一总结阐述。

Corneal compensation of presbyopia:PresbyLASIK:an updated review

The main purpose of this review is to compare and analyze the results of the main PresbyLASIK approaches;central and peripheral.Summary:A comprehensive research was conducted in PUBMED using keywords like“presbyopia correction”,“PresbyLASIK”,“Corneal multifocality”,“Laser blended vision”.We reviewed the PresbyLASIK technique,uncorrected distance visual acuity(UDVA),corrected distance visual acuity(CDVA),uncorrected near visual acuity(UNVA),and corrected near visual acuity(CNVA),and compared the differences between the techniques.

老视矫正的研究进展

老视是一种常见的年龄相关性视力障碍,以渐进性的近视力减退为主要特征。随着我国人口老龄化,老视问题更为突出。老视矫正除传统框架眼镜矫正外,角膜手术、晶状体手术、巩膜手术、药物等相关矫正手段也在不断探索。本文就近年来老视研究的相关文献进行综述。

Pharmacological treatments of presbyopia:a review of modern perspectives

Introduction:Presbyopia affects people from the 4^(th) decade of life and is characterized by accommodative loss that leads to negative effects on vision-targeted health-related quality of life.A non-invasive pharmacological treatment providing near-lenses independence would be a truly groundbreaking approach in the treatment of presbyopia.The purpose of this review is to analyze the emerging pharmacological solutions proposed to address presbyopia.Results:Several ophthalmic eye drops compounds solutions have been described in peer-reviewed papers or presented in ophthalmological tabloids and congresses.Each topical treatment deals with drug combinations aimed to modify one or more factors involved in the accommodative process and have been proposed to be instilled either monocularly or binocularly.It remains unclear how much each drug in the final combined form is involved in the achievement of the outcome and contributes to it.Conclusion:Despite the lack of a completely well understood mechanism,pharmacological control of presbyopia seems to be a possible and very attractive alternative for presbyopic patients.The studies mentioned in this review are to be considered pilot investigations as they involve either a small number of subjects or are single case series.Complete studies are needed to confirm which will be the more effective pharmacological compound for the treatment of presbyopia.

The effects of premium intraocular lenses on presbyopia treatments

Background:Presbyopia has become a global disease affecting the world's aging population.Among various treatments,cataract extraction and intraocular lens(IOL)implantation have become the most popular and common methods of presbyopia correction.During the twentieth century,IOLs have underwent significant innovation and advancements to meet the patients'high demands for functional vision at all distances.Main Text:To meet the increasing needs for excellent near and intermediate vision for daily activities,some premium IOLs with more than one focus have been developed,for example,the refractive MfIOLs,diffractive MfIOLs,extended depth of field(EDOF)IOLs,and accommodating IOLs(AIOLs)were introduced to meet this need.In addition,the add-on MfIOLs have been explored as promising supplementary IOLs for pseudophakic presbyopia.When selecting the MfIOLs,the IOLs'features,patients’characteristics,preoperative eye conditions,and treatment expectations should be considered.Conclusions:In this review,we focus on the multifocal IOLs(MfIOLs)commonly used for presbyopia correction and systematically summarized their optical designs and clinical outcomes.More evidence-based studies are required to provide guidelines for MfIOL selection,provide maximum visual benefits,and develop personalized visual solutions in the future.

激光类手术矫正老视的新进展

随着全球老龄化的加剧,老视逐渐成为一个全球性的问题,老视矫正手术在近些年不断涌现。激光技术的应用为屈光手术带来了极大的便利,同样其在老视的矫正中也发挥着越来越重要的作用,准分子激光和飞秒激光技术的出现,打开了老视手术治疗的新世界,为老视手术矫正带来了新的希望。文章主要就准分子激光和飞秒激光技术在老视手术中的应用以及新进展展开叙述。

SMILE来源的角膜基质透镜临床再利用的研究进展

随着飞秒激光小切口角膜基质透镜取出术(SMILE)的普及,术中大量一片式角膜基质透镜被取出。角膜基质透镜作为手术的额外产物,对其进行基础研究及临床再利用已成为近年来的研究热点。角膜基质透镜薄而透明,来源丰富,成本低廉,具有低免疫源性及良好的组织相容性等优点,是研究细胞和角膜基质的重要来源,也可作为临床上角膜加固、补片移植、屈光矫正及泪道栓塞的良好生物材料。文章就SMILE手术来源的角膜基质透镜在治疗角膜相关疾病,矫治远视及老视,覆盖青光眼引流阀防止其暴露及用于泪道栓等方面的应用进行综述,旨在充分认识其在临床上的再利用,扩大其手术应用范围,为其他眼病的治疗及组织器官中的应用提供新方向。

Fundamentals of Presbyopia: visual processing and binocularity in its transformation

Background:The accommodation has considerable interactions with the pupil response,vergence response and binocularity.The transformation of visual reception processing and the changes of the binocular cooperation during the presbyopia development are still poorly studied.So,the regularities of visual system violation in the presbyopia formation need to be characterized.This study aims to reveal the transformation of visual reception processing and to determine the role of disturbances in binocular interactions in presbyopia formation.Methods:This study included 60 people with emmetropic refraction,uncorrected distance visual acuity 1.0 or higher(decimal scale),normal color perception,without concomitant ophthalmopathology.The first group consisted of 30 people(from 18 to 27 years old)without presbyopia,the second cohort comprised 30 patients(from 45 to 55 years old)with presbyopia.The eyeball anatomy and optics were evaluated using ultrasound biomicroscopy,aberrometry,and pupillometry.The functional state of the visual system was investigated under monocular and binocular conditions.The registration of the disparate fusional reflex limits was performed by the original technic using a diploptic device which facilitated investigation of the binocular interaction under natural conditions without the accommodation response,but with the different vergence load.The disparate fusional reflex was analyzed using the proximal and distal fusion borders,and the convergence and divergence fusion borders.The calculation of the area of binocularity field was performed in cm2.Results:The presbyopia formation is characterized by a change in an intraocular anatomy,optics,visual processing,and binocularity.The processes of binocular interaction inhibition make a significant contribution to the misalignment of the visual perception.The modification of the proximal,distal and convergence fusion borders was determined.It was revealed that 87%of the presbyopic patients had binocularity shortage,whereas the reduction of binocularity field area in extreme grade was seen in 6%of cases.Conclusions:The presbyopia formation is accompanied by a significant reorganization of the visual system activity and by the creation of the new visual processing interactions.These data may be useful in presbyopia surgery.

A systematic review of reading tests

Adequate near and intermediate visual capacity is important in performing everyday tasks,especially after the introduction of smartphones and computers in our professional and recreational activities.Primary objective of this study was to review all available reading tests both conventional and digital and explore their integrated characteristics.A systematic review of the recent literature regarding reading charts was performed based on the PubM ed,Google Scholar,and Springer databases between February and March 2021.Data from 11 descriptive and 24 comparative studies were included in the present systematic review.Clinical settings are still dominated by conventional printed reading charts;however,the most prevalent of them(i.e.,Jaeger type charts)are not validated.Reliable reading capacity assessment is done only by those that comply with the International Council of Ophthalmology(ICO)recommendations.Digital reading tests are gaining popularity both in clinical and research settings and are differentiated in standard computer-based applications that require installation either in a computer or a tablet(e.g.,Advanced VISION Test and web-based ones e.g.,Democritus Digital Acuity Reading Test requires no installation).It is evident that validated digital tests will prevail in future clinical or research settings and it is upon ophthalmologists to select the one most compatible with their examination routine.