Is there a hyperopic shift in myopic eyes during the presbyopic years?

Grosvenor, Theodore; Skeates, Peter D

doi:10.1111/j.1444-0938.1999.tb06654.x

Cited by 16 publications

(23 citation statements)

References 23 publications

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“…It might be remarked here that cross‐sectional studies have inferred a negligible role for the cornea, certainly in late‐onset myopia 13,14 . Evidence of ocular anatomical structural change specific to this IP age group appears to be limited, but the inferences from longitudinal and cross‐sectional studies on late adult‐onset myopes are instructive 15,16 . Any suggestion of significant changes in crystalline lens profile and power extending beyond the later teenage years into adulthood is weak or equivocal 12,17 .…”

Section: Discussionmentioning

confidence: 83%

“…Evidence of any sudden myopic refractive shift in presbyopic subjects is more obscure. A previous longitudinal analysis of optometric practice data has reported that 15% of middle aged myopes (aged >45 years) showed a myopic shift of −0.50 D or more: this change was noted most especially in the younger presbyopes, but because patients’ refractive change was averaged across a decade any instances of abrupt refractive shift cannot be identified in the published material 16 . The myopic increase in our subjects specifically during IP was only detectable within a period of a year or two immediately prior to individual clinical indication of a first near add requirement.…”

Section: Discussionmentioning

confidence: 96%

“…Refractive surgeons have previously been advised that adult myopia is not necessarily a fixed characteristic 42 . Furthermore, once the presbyopic threshold has been crossed a relative reduction in myopia might arise which, 16 in turn, could have implications for the individual’s post‐photorefractive VA 43 . It is thus conceivable that patients who have undergone photorefractive elective surgery and who have careers in the armed forces, emergency services and in occupations involving driving or flying, for example, might be impacted in middle age by a modest myopic refractive shift.…”

Section: Discussionmentioning

confidence: 99%

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Patterns of refractive change in myopic subjects during the incipient phase of presbyopia: a preliminary study

Pointer¹,

Gilmartin²

2011

Ophthalmic Physiologic Optic

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UKCitation information: Pointer JS & Gilmartin B. Patterns of refractive change in myopic subjects during the incipient phase of presbyopia: a preliminary study. Ophthalmic Physiol Opt 2011Opt , 31, 487-493. doi: 10.1111Opt /j.1475Opt -1313Opt .2011 Abstract Purpose: Changes in refractive error are well documented over the typical human lifespan. However, a relatively neglected period of investigation appears to be during the late fourth decade; this is at the incipient phase of presbyopia (IP), where the amplitude of accommodation is much reduced and approaches the level where a first reading addition is anticipated. Significantly, informal clinical observation has suggested a low incidence of an unexpected abrupt increase in myopia during IP. Methods: We investigated this alleged myopic shift retrospectively by mapping the longitudinal refraction histories of normally-sighted 35-44 years old British White patients previously examined in routine optometric practice. The refractive trends in the right eyes of healthy myopic subjects (spherical equivalent refraction, SER £)0.50 D: N = 39) were analysed relative to that point at which a first near dioptric addition was considered to be clinically useful. Results: A refractive change was evident in some subjects during IP; viz, an abrupt increase in myopic SER of between )0.50 and )0.75 D. These individuals (N = 8) represented 20% of the study population of myopic incipient presbyopes. Beyond the pivotal point of the first near addition the longitudinal refraction stabilized in these subjects. In contrast, and as the extent of the available longitudinal data would permit, the remaining myopic eyes maintained an approximately stable refractive trend throughout IP and beyond. Conclusions: The anatomical or physiological basis of this specific late (nondevelopmental) abrupt myopic refractive change is an intriguing issue. Axial (vitreous chamber elongation), corneal (contour) and lenticular (profile and index) power bases, alone or in concert, might be considered candidates for this hitherto unexplored refractive phenomenon. Although necessarily obtained under conventional conditions of central (0 deg) fixation, our data might also be a reflection of the recent recognition of the possible influence of the peripheral refraction upon the axial error. Consideration of this material provides an impetus for further research, including ocular biometry, a reappraisal of ciliary zonular functional anatomy, renewed investigation of the AC/A ratio, and the extent of a centripetal refractive influence on myopia development.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Patterns of refractive change in myopic subjects during the incipient phase of presbyopia: a preliminary study

Pointer¹,

Gilmartin²

2011

Ophthalmic Physiologic Optic

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“…Some caution must be excercised in the interpretation of the results shown, since most of the data are transverse, and there may be some bias in the selection of the subjects studied. Further, effects may vary with the initial refraction, with some myopes showing anomalous behaviour . However, as shown in Figure , there is broad agreement among different authors that from the age of 30–40 years there is typically a slow drift towards hyperopia (at about + 0.04 D/year), the total hyperopic shift typically amounting to about 1–2 D by the age of 70.…”

Section: Changes With Age In Accommodation and Refractionmentioning

confidence: 78%

“…Thus, at least in the phakic eye, presbyopic corrections must be flexible enough to cope with changes in both the required distance correction and the addition. This is straightforward with spectacle and contact lens corrections, which can easily be modified, but may be more difficult with some surgical techniques, which by their nature are never completely reversible …”

Section: Changes With Age In Accommodation and Refractionmentioning

confidence: 99%

Developments in the correction of presbyopia I: spectacle and contact lenses

Charman

2013

Ophthalmic Physiologic Optic

147

136

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Purpose: To outline the refractive problems associated with presbyopia and to review the basis and relative merits of currently-available methods for their correction, with detailed consideration of spectacle and contact lens approaches. Contents: In the developed world, most of the present population will spend roughly half their lives as presbyopes. The well-known presbyopic changes with age in amplitude of accommodation and required near addition are briefly reviewed, together with the less widely acknowledged slow drifts that occur in distance refraction. The desirability of restoring to presbyopes clear vision for objects at any distance, ideally corresponding to vergences within the range of at least 0 to À5 D, in any viewing direction, is stressed. A general outline is given of possible corrective methods. Methods which satisfy the needs of a 50 year-old may not be suitable for the 80 year-old. Corrections may involve both fixed-and variablefocus lens systems, and surgical methods which modify the optics of the cornea, replace the crystalline lens with different fixed optics, or attempt to at least partially restore active accommodation. Some more recent methods of spectacle and contact lens correction are described in more detail. Particular attention is given to recent commercially-developed spectacles in which the corrective power can be varied actively by either mechanical (liquid-filled deformable lenses or Alvarez lenses) or electrical (liquid crystal lenses) means to allow objects at different distances to be seen clearly. Contact lens corrections show less progress and are still preferred only by a minority of older patients, most of whom are early presbyopes. Summary: The rising proportion of presbyopes in the population, covering an age span of around 40 years, represents both a problem for those concerned with giving their patients the best vision possible at both far and near viewing distances and a commercial opportunity. Traditional single-vision distance and near, bifocal, and progressive spectacle lens solutions, together with contact lens modalities for presbyopic correction, are being challenged by a variety of new approaches. It remains to be seen whether the latter will receive wide acceptance in practice.

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