Accommodation And Presbyopia IV Flashcards
What are the DIRECT causes of presbyopia
Refractive error
Ocular aberrations
Pupil size
Focusing ability
What do we want to do to fix th refractive error aspect of presbyopia
Bifocals and monovsion
What do we want to do to fix the ocular aberration aspect of presbyopia
Multifocality
What do we want to do to fix the pupil size for presbyopia
Small pupils
What do we want to do to fix the focusing ability in presbyopia
Accommodation restoration
Non surgical presbyopia correction
Specs and CL
Specs for presbyopia correction
Readers, bifocals/trifocals, progressive lenses
CL for presbyopia correction
Bifocal, multifocal, translating, monovision
Surgical options to fix presbyopia
Accommodative IOLs
Multifocal IOLs
Monovision
Corneal surgical correction for presbyopia
- excimer laser vision correction (LASIK, PRK)
- lamellar keratoplasty (ReLex)
Corneal inlays for presbyopia correction
Pinhole
Center-near
Center-distance
Laser surgery for presbyopia correction
- intracor
- femtosecond lentotomy
- injectable filler (medennium)
Conclusions regarding spherical aberration in presbyopia
While spherical aberration can theoretically be used to increase depth of focus, the improvement is less impressive when factoring in the inability to control for other higher order aberrations and pupil size
Conclusions regarding small pupils and presbyopia correction
- small pupil is more effective than a multifocal design in increasing depth of focus and is effective regardless of lower and higher order aberrations
- especially effective for individuals with large or aberrated pupils
Future of presbyopia
Monovision expected to become less common
-non ideal situation
Multifocal designs
Often rejected by ophthalmologists, optometrists, etc
-seen as non ideal and poor trade off
Small pupil design
Just beginning to appear on the market
-not ideal due to possible problems with night vision and or future eye treatments
Future of accommodative restoration
- scleral expansion
- femtosecond lentotomy
- accommodative IOLs
- eye exercises
- homeopathic
- injectable filler
Accommodative IOLs future
Disappointing results
Lack of lens movement
Opacifiction of capsular bag
Fibrosis, increasing with time
Utilize movement of ciliary muscle or direct impulses through the nervous system rather than the zonules or the lens capsule
True accommodating IOL
