A review of the surgical options for the correction of presbyopia

Abstract

Presbyopia is an age-related eye condition where one of the signs is the reduction in the amplitude of accommodation, resulting in the loss of ability to change the eye's focus from far to near. It is the most common age-related ailments affecting everyone around their mid-40s. Methods for the correction of presbyopia include contact lens and spectacle options but the surgical correction of presbyopia still remains a significant challenge for refractive surgeons. Surgical strategies for dealing with presbyopia may be extraocular (corneal or scleral) or intraocular (removal and replacement of the crystalline lens or some type of treatment on the crystalline lens itself). There are however a number of limitations and considerations that have limited the widespread acceptance of surgical correction of presbyopia. Each surgical strategy presents its own unique set of advantages and disadvantages. For example, lens removal and replacement with an intraocular lens may not be preferable in a young patient with presbyopia without a refractive error. Similarly treatment on the crystalline lens may not be a suitable choice for a patient with early signs of cataract. This article is a review of the options available and those that are in development stages and are likely to be available in the near future for the surgical correction of presbyopia.

Visual outcomes 24 months after LaserACE

“…Surgical correction could be done with either corneal refractive surgery or intraocular lens replacement [3]. Corneal refractive procedures include excimer ablation to create monovision or multifocality, conductive keratoplasty using radiofrequency waves, and inlays [4]. Intraocular lens replacement uses monofocal lenses for monovision, multifocal implants, accommodative implants, and most recently, extended depth of focus (EDOF) intraocular implants [4].…”

“…Corneal refractive procedures include excimer ablation to create monovision or multifocality, conductive keratoplasty using radiofrequency waves, and inlays [4]. Intraocular lens replacement uses monofocal lenses for monovision, multifocal implants, accommodative implants, and most recently, extended depth of focus (EDOF) intraocular implants [4]. Of these modalities, only intraocular accommodative lenses attempt to restore accommodation to the presbyopic eye [5].…”

Evaluation of activities of daily living following pseudophakic presbyopic correction

“…Laser-assisted corrections [20–23], intrastromal rings [24], corneal inlays [25, 26] and lenticular approaches [27–29] attempt to address the presbyopia-related productivity loss and variable optical outcomes and satisfaction rates have been reported. Despite the variance of the published data, it is widely accepted that lenticular approaches offer an almost permanent surgical outcome for presbyopia since they address the ongoing or upcoming cataract changes of the lens as well, which are common in middle-aged and elderly presbyopes.…”

Update on Presbyopia-correcting Drops

“…A drop for presbyopia treatment must create a similar and longlasting effect on pupil apertures to be successful. 7 The commercial and noncommercial drops used or tried in the treatment of presbyopia are given in Table 1. Reducing pupil size is not without adverse effects.…”

“…[3][4][5] There are some surgical modalities including refractive lens exchange, mono-vision laser-assisted in situ keratomileusis (LASIK), blended vision LASIK, multifocal or accommodating intraocular lens (IOL) implantations and corneal inlay implantation for the treatment of presbyopia. [4][5][6][7] Nonsurgical treatments for presbyopia include the use of near-glasses and contact lenses. 5 Nowadays, otorities are speculating about topical parasympathomimetic drop treatment for pharmacological control of presbyopia, which is a nonsurgical option for the vast majority of people with near vision spectacle dependence over 40 years old.…”