Accommodative and Nonaccommodative Treatment of Presbyopia

Question 1

Helmholtz hypothesis or capsular theory of accommodation

Answer 1

during distance vision the ciliary muscle is relaxed and the zonular fibers are in a state of “resting” tension. With accommodative effort an anterior movement of the ciliary muscle annular ring and a release of tension on the zonules occur. accommodation. The reduced zonular tension allows the elastic capsule of the lens to contract, causing a decrease in equatorial lens diameter and an increase in the curvature of the anterior and posterior lens surfaces. This “rounding up” of the lens yields a corresponding increase in its dioptric power, as is necessary for near vision. equatorial edge of the lens moves away from the sclera during accommodation and toward the sclera when accommodation ends

Question 2

Scleral Surgery - objective

Answer 2

to increase zonular tension by weakening or altering the sclera over the ciliary body to allow for its passive expansion

Question 3

Scleral Surgery - techniques

Answer 3

scleral incisions over the ciliary body (anterior ciliary sclerotomy), placement of scleral expansion bands. LaserACE procedure - employs a laser to increase the plasticity of the sclera

Question 4

Accommodating Intraocular Lenses

Answer 4

modified silicone plate–haptic lenses. These lenses may allow anterior movement of the lens during accommodation

Question 5

Nonaccommodative Treatment of Presbyopia

Answer 5

Monovision, Conductive Keratoplasty, Multifocal Intraocular Lens Implants, Custom or Multifocal Ablations, Corneal Intrastromal Femtosecond Laser Treatment, Corneal inlays