Presbyopiekorrektur mittels Intraokularlinsen

Modern cataract surgery has advanced tremendously over the past 20 years. Improved surgical techniques, as well as improved implant materials and designs, have enlarged patient profiles and indications not only for cataract surgery, but also for refractive lens exchange surgery. This has also created much higher patient expectations. The loss of accommodation is a loss of quality of life for presbyopic and especially young pseudophakic patients. Multifocal intraocular lenses (MIOL) have been implanted since 1986, starting with 2-3 zone refractive and diffractive designs. Due to the surgical techniques available at that time, MIOL decentration and surgically induced astigmatism were possible complications. In addition, reduced contrast perception and increased glare were common problems of MIOL because of their optical principles. New developments in this field in recent years such as the folding, multizonal, progressive refractive MIOL and aspheric diffractive MIOL in combination with improved surgical techniques have overcome those initial problems. Therefore, modern MIOL (and in the future also accommodative IOL) can be considered not only for the correction of aphakia but also for refractive purposes.

Ausgleich der Presbyopie mit Kontaktlinsen

Contact lens fitting for presbyotic patients needs more than simple fitting shill; patients need additional psychological support. The wearer has to accept optical quality reduction due to the multifocality of the lens design. In general, the technical fitting of presbyotic contact lenses is comparable to monofocal systems. They work with the same rules of performance. The difference lies in the principles of correction by the lens itself. Simple presbyotic systems use uncorrected optical aberration to widen depth perception. These lenses are suitable for young presbyopes, up to a need of 1 diopter plus power for near vision. Uncorrected aspherical designs have a multifocal effect which can be used for presbyotic lenses. There are contact lenses on the market with simultaneous imaging, which is based on concentric rings around the near or distance centre. Another principles are based on segmented reading portions in the lower part of the lens, also called alternating systems. These very few design variations are the basis for the various specific models which are sold on the market today. The results of the fitting can never be foreseen as subjective and psychological aspects of the wearer overlay the objective results. Thus, the fitter needs experience and patient understanding, combined with fundamental knowledge of the specific lens type used.

A Population-Based Assessment of Presbyopia in the State of Andhra Pradesh, South India: The Andhra Pradesh Eye Disease Study

PURPOSE

To determine the prevalence of presbyopia in the state of Andhra Pradesh in south India.

METHODS

Comprehensive ocular examinations including logMAR (logarithm of the minimum angle of resolution) distance and near (presenting and best corrected) visual acuity, slit lamp biomicroscopy of the anterior segment, and dilated posterior segment examinations were performed using a standardized protocol for subjects identified through a random cluster-sampling strategy in Andhra Pradesh. Information of difficulty in performing near tasks was collected as part of a visual function questionnaire administered to all subjects. A person was defined as having presbyopia if the person required an addition of at least 1.0 D in either eye for near vision in addition to their best corrected distance correction to improve near vision to at least N8 and if they had graded lens opacities (Lens Opacities Classification System [LOCS III] system).

RESULTS

Examined in the study were 5587 subjects 30 years of age or older (mean age 47.5+/-13.0 years). The age-, gender-, and area-adjusted prevalence of presbyopia was 55.3% (95% confidence interval [CI]: 54.0-56.6). One third (n=1173; 30.0%) of the 3907 subjects with presbyopia were currently using spectacles. Of the 2734 subjects with presbyopia and not using spectacles, 528 (19.3%) had moderate to severe difficulty in reading small print, and 2085 (76.3%) had moderate to severe difficulty in recognizing small objects and performing near work, including 1057 (38.6%) subjects who were unable to manage any near work. On multivariate analysis, female sex (OR: 1.4, 95% CI: 1.1-1.8), rural residence (OR: 1.5, 95% CI: 1.2-1.8), alcohol consumption (OR: 0.8, 95% CI: 0.6-0.9), nuclear opacity of the lens greater than grade 2 LOCS III (OR: 4.8, 95% CI: 1.4-16.8), myopia (OR: 1.6, 95% CI: 1.3-2.1), and hyperopia (OR: 3.6, 95% CI: 2.7-5.2) were associated with presbyopia.

CONCLUSIONS

The high prevalence of presbyopia and the stated effect on performing activities related to near vision needs to be translated into programs and strategies that specifically target presbyopia.

Population-Based Study of Presbyopia in Rural Tanzania

OBJECTIVE

To determine the prevalence of presbyopia in a rural African population.

DESIGN

Cross-sectional prevalence study.

PARTICIPANTS

One thousand seven hundred nine persons age 40 years and older who resided in 3 villages and randomly selected neighborhoods of Kongwa town, Tanzania.

METHODS

Eligible persons were refracted and given best distance correction. Near vision was tested and corrected to the nearest 0.5 diopter. Presbyopia was defined as at least 1 line of improvement on a near visual acuity chart with an addition of a plus lens.

RESULTS

A total of 61.7% of eligible participants were presbyopic. A higher prevalence of presbyopia was associated with increased age, female gender, higher educational level, and residence in town (odds ratio = 3.09; 95% confidence interval: 2.46-3.90). The odds of developing presbyopia increased 16% per year of age from age 40 to 50, but the increase was nonsignificant at 1% per year after age 50. More severe presbyopia was associated with female gender and less with education.

CONCLUSIONS

This study provides the first population-based data on prevalence of presbyopia in a large, random sample of older Africans and suggests a high rate of presbyopia. Presbyopia plateaus after age 50, and it is more common in females. In addition, the 3-fold increased odds in town versus village dwellers was unexpected and suggests that research of other factors, including environmental factors, is warranted.

Impact of Presbyopia on Quality of Life in a Rural African Setting

PURPOSE

To determine the impact of uncorrected presbyopia on quality of life in rural Tanzania.

DESIGN

Cross-sectional study.

PARTICIPANTS

Population-based sample of 1709 village and town-dwelling adults aged 40 and older in the Kongwa district in rural Tanzania.

METHODS

Subjects underwent distance and near visual acuity testing to determine presbyopia. A near vision-related quality of life questionnaire was administered by trained interviewers to determine the degree of self-rated difficulty with tasks appropriate to life in a rural African setting, and how much near vision loss contributed to this difficulty.

MAIN OUTCOME MEASURES

Near vision-related quality of life.

RESULTS

Complete data were available for 1564 (92%) of the subjects. The prevalence rate of presbyopia was 62%. The majority of presbyopes (94%) did not have corrective near vision glasses. Compared with nonpresbyopes, being presbyopic increased the odds of reporting some difficulty with near vision tasks by 2-fold (odds ratio [OR], 2.04; 95% confidence interval [CI]: 1.57-2.66), odds of reporting moderate difficulty by 5-fold (OR 5.01; 95% CI: 3.19-7.89), and odds of reporting high difficulty by >8-fold (OR 8.52; 95% CI 3.13-23.10). The degree of presbyopia was associated with increasing difficulty with daily tasks (P<0.0001).

CONCLUSIONS

This is the first study to demonstrate that uncorrected presbyopia has a significant impact on vision-related quality of life in a rural African setting. The high prevalence of presbyopia, and increased aging of the population in developing countries, suggests that the World Health Organization's Vision 2020 refraction agenda should place greater emphasis on presbyopia.

Vision and hearing loss in older adults: "Double trouble"

Recent studies indicate that by age seventy, 21% of the people living in the United States have both vision and hearing loss. Dual sensory loss in the elderly has a significant effect on an individual's ability to socialize, communicate with others, and live independently. This article addresses the issues faced by older individuals who are hard of hearing and blind or visually impaired. Common causes and behavioral signs of hearing and vision loss are discussed. An emphasis is placed on the functional implications of the dual sensory impairment and possible accommodations and communication strategies are outlined

A retrospective study on presbyopia onset and progression in a Hispanic population

BACKGROUND

This study evaluates differences in age and presbyopia progression between an ethnic Hispanic and a non-Hispanic patient population.

METHODS

Patient records from the Optometric Center of Los Angeles were examined retrospectively from 1998 through 2001. The first part of the study compared ages at onset and progression of presbyopia as a function of ethnicity. The second part of the study compared the amplitude of accommodation for the cohort of patients to Hofstetter's expected norms.

RESULTS

A total of 332 patient records were evaluated: 61% (n = 203) Hispanic and 39% (n = 129) non-Hispanic. For an add power of +0.75 D, presbyopia developed in the reviewed Hispanic population at 39.31 years of age in comparison to development in non-Hispanics at 40.22 years. Hispanics also had a similar progression of reading add power (0.105 D/year) as compared to non-Hispanics (0.097 D/year) (t= 0.798, p = 0.43). The progression of amplitude of accommodation for the Hispanic (amplitude = 11.2 - 0.132 x age) and non-Hispanic populations (amplitude = 9.72 - 0.18 x age) (t= 0.0997, p = 0.92) were comparable, but both groups show a slower decline of amplitude when compared to Hofstetter's norms (p< 0.001).

CONCLUSIONS

No statistically significant difference in the age at onset and progression of presbyopia was found between Hispanic and non-Hispanic patients; however, both groups of patients have a later onset and slower progression of presbyopia when compared to Hofstetter's norms.

Optics of conductive keratoplasty: implications for presbyopia management

PURPOSE

To define the corneal optics of conductive keratoplasty (CK) and assess the clinical implications for hyperopia and presbyopia management.

METHODS

Four analyses were done. (1) Multifocal effects: In a prospective study of CK, uncorrected visual acuity (UCVA) for a given refractive error in 72 postoperative eyes was compared to control eyes. (2) Surgically induced astigmatism (SIA): 203 eyes were analyzed for magnitude and axis of SIA. (3) Higher-order optical aberrations: Corneal higher-order optical aberrations were assessed for 36 eyes after CK and a similar patient population after hyperopic laser in situ keratomileusis (LASIK). (4) Presbyopia clinical trial: Visual acuity, refractive result, and patient questionnaires were analyzed for 150 subjects in a prospective, multicenter clinical trial of presbyopia management with CK.

RESULTS

(1) 63% and 82% of eyes after CK had better UCVA at distance and near, respectively, than controls. (2) The mean SIA was 0.23 diopter (D) steepening at 175 degrees (P < .001); mean magnitude was 0.66 D (SD, 0.43 D). (3) After CK, composite fourth- and sixth-order spherical aberration increased; change in (Z12) spherical aberration alone was not statistically significant. When compared to hyperopic LASIK, there was a statistically significant increase in composite fourth- and sixth-order spherical aberration (P < .01) and spherical aberration (Z12) alone (P < .02); spherical aberration change was more prolate after CK. (4) After the CK monovision procedure, 80% of patients had J3 or better binocular UCVA at near; 84% of patients were satisfied. Satisfaction was associated with near UCVA of J3 or better in the monovision eye (P = .001) and subjectively good postoperative depth perception (P = .038).

CONCLUSIONS

CK seems to produce functional corneal multifocality with definable introduction of SIA and higher-order optical aberrations, and development of a more prolate corneal contour. These optical factors may militate toward improved near vision function.

Magnitude and determinants of refractive error in Omani school children

OBJECTIVE

To estimate the magnitude and determinants of refractive error in school children, a study was undertaken to review the school screening and refraction data.

METHODS

Trained physicians screened 416,157 students to evaluate their visual status and identified 28,765 students with defective vision. Refractionists refracted 25,733 (89.5%) of them, determined the refractive error and prescribed spectacles. Students with ocular co-morbidity and visual disability were re-examined and treated by the ophthalmologists. This study was conducted between June 2003 and December 2003 in the Ministry of Health, Muscat, Sultanate of Oman.

RESULTS

The prevalence of myopia was 4.1% (95% confidence interval [CI] 4.06-4.18). It was higher among female than male students [rate ratio (RR) 1.69 (95% CI 1.64-1.74)]. The rate was more in students of higher age groups (chi2 = 11,179 degrees of freedom = 2 p<0.00001). Regional variation in myopic trend was marked. The prevalence of hypermetropia was 0.4% (95% CI 0.37-0.41). However, it could be an underestimation as presence of accommodative spasm was not taken into account. The risk of low vision disability was significantly higher in male students than female students. The prevalence of ambiopia was 0.3%. It was significantly higher in male than female students. First primary students had strabismus of 0.5%.

CONCLUSION

The study enabled to understand trends of refractive error in Omani children (Arabic tribe) and demonstrated the importance of vision screening in providing timely eye care and identifying visually disabled school children.

Imaging scleral expansion bands for presbyopia with optical coherence tomography

A 57-year-old woman was treated for mild presbyopia with implantation of scleral expansion bands (SEB). Although near vision was temporarily restored, the effect dissipated after 1 year. Slitlamp-adapted optical coherence tomography (OCT) at 1310 nm allowed precise cross-sectional visualization of the hyporeflective intrascleral segments. The OCT method provided precise images of the segment depth and thickness, the scleral thickness at the scleral spur, the anterior chamber angle, and the angle-opening distance. Intrascleral tilting of 1 segment was seen; this required removal of the SEB because of marked foreign-body sensation. Noncontact, slitlamp-adapted OCT can be used to evaluate scleral changes after SEB implantation.

Criteria for prescribing optometric interventions: literature review and practitioner survey

The core function of optometrists is the prescribing of refractive corrections, yet a literature review revealed a lack of evidence-based research on criteria for determining when a refractive correction is required. The reported criteria used by practising optometrists were investigated using a questionnaire to survey prescribing habits for borderline hypermetropia, presbyopia, astigmatism, and horizontal and vertical heterophoria. Thirty-eight questionnaires were returned and the results analysed. We calculated the 'cut off' point above which the anomaly would be corrected over 50% of the time that it was encountered. There was a large variation for each category, but it was clear that the presence or absence of symptoms was an important factor for most optometrists when deciding whether to correct a small error. It was found that for symptomatic patients, most optometrists would correct an anomaly if it reached: +1.00 D of hypermetropia, a reading addition of +0.75 D for presbyopia, -0.75 DC of astigmatism, 1.5 prism dioptres (Delta) of horizontal aligning prism, and 1 Delta of vertical dissociated heterophoria. For asymptomatic patients, optometrists would not correct any of the hypermetropic anomalies or heterophorias that were specified in our questionnaire. However most would correct a presbyopic error of +1.50 D or above, or an astigmatic error of -1.50 DC or above, even in the absence of symptoms. These results were compared with previously published guidelines.

Relationship between age and presbyopic addition using a sample of 3,645 examinations from a single private practice

BACKGROUND

This study uses information collected in a private optometric practice to describe the relationship between age and the add power needed to correct presbyopia.

METHODS

Computer-assisted data analysis with a database management program, Q&A, and Microsoft Excel was used to assess the relationship between age and presbyopic addition. Data collected from 3,645 examinations by one practitioner in a single private practice--over a period of approximately 23 years--were entered into the database. The patient base was primarily white and about equally divided between the sexes. The practitioner generally used the fused cross cylinder for the tentative presbyopic addition and refined this by patient preference and best visual acuity at near, all using a carefully determined near working distance.

RESULTS

The presbyopic addition increased rapidly in patients from ages 40 to 50 years, the rate at age 40 being about 0.22 diopters per year and the average rate during the 40- to 50-year-old decade being about 0.12 diopters per year, or approximately 0.25 diopters every 2 years. After the patient reaches 50 years of age, the presbyopic addition increased more slowly, at the rate of approximately 0.03 diopters per year--or approximately 0.25 diopters in 8 years.

CONCLUSIONS

Quantitative data taken from more than 3,600 refractions showed a nearly parabolic relationship between age and presbyopic addition from approximately the age of 40 to 75 years.

[Effects of presbyopia on clinical phoria]

BACKGROUND

Due to accommodation-vergence cross-link we can expect that presbyopia will affect vergence as well. From investigations of cross-link as function of age one may assess strain of visual system due to presbyopia. Furthermore, this observation will give hints on innervation of ciliary muscle.

MATERIAL AND METHOD

Vergence is assessed as function of stimulus of accommodation in 27 subjects (24-65 years).

RESULTS

Presbyops tend to be exophoric for near vision. Vergence is linked to accommodation by means of a quadratic polynome rather than by a linear function.

CONCLUSIONS

We may expect, that missing vergence strains visual system of presbyops. Results support Hess-Gullstrand theory of presbyopia and indicate a loss of innervation of ciliary muscle with increasing age.

[Selected problems with ocular accommodation in children and youth]

This paper intends to present some accommodative disturbances which cause difficulties in reading and should be differentiated from dyslexia. The work describes the way of evaluation of accommodative convergence to accommodation rate (AC/A ratio). Clinical forms of two types of nonrefractive accommodative convergence excess connected with high AC/A ratio, namely hyperkinetic and hypoaccommodative, are presented. In hyperkinetic type, disturbances of ocular movements coordination during reading prevail. Patients with hypoaccommodation disorders suffer from youth presbyopia. The paper describes the ways of treatment of these disorders.

A study of racial differences in age at onset and progression of presbyopia

BACKGROUND

This study investigated reported differences in age at onset and progression of presbyopia between black and white patients.

METHODS

The records of 692 primary care patients (242 black and 450 white), ages 35 to 55 years, who received eye examinations at the University of Alabama at Birmingham School of Optometry (December 1, 1992 and May 31, 1993), were reviewed retrospectively. Regression models were used to compare age at onset and progression of presbyopia of study subjects with respect to race. Also, the effect of socioeconomic status (SES) was assessed for a subset of 373 subjects.

RESULTS

No significant differences in the age at onset or progression of presbyopia were detected between black and white patients (p > 0.05). Similarly, there were no significant differences in age at onset and progression of presbyopia with respect to socioeconomic status.

CONCLUSIONS

Contrary to previous studies, the onset and progression of presbyopia of black and white patients in this study population did not differ significantly. This result suggests other factors may play a role in previously reported variation of presbyopia in black and white patients. Similarly, variations in income status did not significantly impact the onset and progression of presbyopia. Further study is needed to corroborate or refute these findings.

Comparison of bifocal and progressive addition lenses on aviator target detection performance

The objective of this project was to determine if the type of presbyopic correction worn by aviators, conventional bifocal versus progressive addition lenses (PAL's), differentially affects aviator visual search performance. Experienced aviators, most with tactical fighter aircraft experience, searched for high-contrast targets under simulated dawn/dust (mesopic) lighting conditions (approximately 3.0 cd/m2) while wearing either a standard bifocal (ST-25) or PAL spectacle correction. Latency of locating high-contrast targets under these viewing conditions was differentially affected by the type of presbyopic correction used. Specifically, compared to a standard bifocal (ST-25), a PAL correction (Varilux Infinity) significantly lowered the time needed to locate static targets at a cockpit instrument viewing distance (83 cm). Accuracy of target location responses was not affected by the type of correction used. In addition, 7 months post-experiment, 7 of the 12 participants (58%) indicated that they used their PAL correction exclusively when flying the T-39 Sabre Liner. Three subjects (25%) used their PAL correction intermittently (primarily at night) when flying and two subjects preferred not to use the PAL's. These results suggest that relative to bifocals, speed of responding to static targets at intermediate viewing distances may be improved by wearing PAL's, and that subjects were able to adapt to PAL lenses quickly in a laboratory setting, using them later in a functional aviation environment.

Difficult people with simple problems: asymmetric presbyopia

A contentious middle-age patient inadvertently obstructs the management of a simple presbyopic problem related to asymmetric accommodative loss.

Clinical evaluation of 14 patients with the Charles Bonnet syndrome (isolated visual hallucinations)

A group of 14 patients with isolated visual hallucinations who met the criteria proposed by Gold and Rabins for Charles Bonnet syndrome (with the exception of the criterion "hallucinations are stereotyped") underwent psychiatric, neurologic, and ophthalmologic tests. Additional common characteristics of the hallucinations included the absence of personal meaning of the content of the hallucinations and the disappearance of the hallucinations when the patients closed their eyes. There was no evidence for a relationship of the syndrome to psychiatric disorders. In the majority of cases, ocular pathology and neurologic disturbances were diagnosed. There was also evidence that most patients were suffering from social isolation. From these data it is concluded that a combination of factors is probably responsible for the Charles Bonnet syndrome.

Sensory impairment in late-life schizophrenia

We reviewed 27 published studies examining a possible association between sensory (visual or hearing) impairment and late-life psychosis with paranoid features. A majority of these investigations supported the postulated association between hearing impairment and late-onset schizophrenia or paranoid disorder. Many of the published studies, however, had important methodological limitations. In a case-control study, we assessed visual and hearing impairments in 87 middle-aged and elderly subjects (16 with late-onset schizophrenia, 25 with early-onset schizophrenia, 20 with mood disorder, and 26 normal comparison subjects). Visual and hearing impairments were assessed in a blind manner by means of standardized quantitative assessments. Compared with normal subjects, both of the schizophrenia groups and the mood disorder group had greater impairment in most variables of corrected visual acuity and in self-reported hearing deficit, but not in uncorrected (constitutional) visual acuity or on pure-tone audiometry. Our results suggest that the observed relationship between sensory impairment and late-life psychosis may be due, at least in part, to a suboptimal correction of sensory deficits in older psychiatric patients.