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Craig JP, Barsam A, Chen C, Chukwuemeka O, Ghorbani-Mojarrad N, Kretz F, Michaud L, Moore J, Pelosini L, Turnbull AMJ, Vincent SJ, Wang MTM, Ziaei M, Wolffsohn JS. BCLA CLEAR Presbyopia: Management with corneal techniques. Cont Lens Anterior Eye 2024:102190. [PMID: 38851946 DOI: 10.1016/j.clae.2024.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
Corneal techniques for enhancing near and intermediate vision to correct presbyopia include surgical and contact lens treatment modalities. Broad approaches used independently or in combination include correcting one eye for distant and the other for near or intermediate vision, (termed monovision or mini-monovision depending on the degree of anisometropia) and/or extending the eye's depth of focus [1]. This report provides an overview of the evidence for the treatment profile, safety, and efficacy of the range of corneal techniques currently available for managing presbyopia. The visual needs and expectations of the patient, their ocular characteristics, and prior history of surgery are critical considerations for patient selection and preoperative evaluation. Contraindications to refractive surgery include unstable refraction, corneal abnormalities, inadequate corneal thickness for the proposed ablation depth, ocular and systemic co-morbidities, uncontrolled mental health issues and unrealistic patient expectations. Laser refractive options for monovision include surface/stromal ablation techniques and keratorefractive lenticule extraction. Alteration of spherical aberration and multifocal ablation profiles are the primary means for increasing ocular depth of focus, using surface and non-surface laser refractive techniques. Corneal inlays use either small aperture optics to increase depth of field or modify the anterior corneal curvature to induce corneal multifocality. Presbyopia correction by conductive keratoplasty involves application of radiofrequency energy to the mid-peripheral corneal stroma which leads to mid-peripheral corneal shrinkage, inducing central corneal steepening. Hyperopic orthokeratology lens fitting can induce spherical aberration and correct some level of presbyopia. Postoperative management, and consideration of potential complications, varies according to technique applied and the time to restore corneal stability, but a minimum of 3 months of follow-up is recommended after corneal refractive procedures. Ongoing follow-up is important in orthokeratology and longer-term follow-up may be required in the event of late complications following corneal inlay surgery.
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Affiliation(s)
- Jennifer P Craig
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK.
| | | | - Connie Chen
- Department of Optometry, Chung Shan Medical University, Taichung City, Taiwan
| | - Obinwanne Chukwuemeka
- Cornea, Contact Lens and Myopia Management Unit, De-Lens Ophthalmics Family and Vision Care Centre, Abuja, Nigeria
| | - Neema Ghorbani-Mojarrad
- School of Optometry and Vision Science, University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | | | | | | | - Andrew M J Turnbull
- Royal Bournemouth Hospital, University Hospitals Dorset, UK; Faculty of Life and Health Sciences, Ulster University, UK
| | - Stephen J Vincent
- Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - Michael T M Wang
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Mohammed Ziaei
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - James S Wolffsohn
- Department of Ophthalmology, Aotearoa New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; College of Health & Life Sciences, Aston University, Birmingham, UK
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2
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Wolffsohn JS, Berkow D, Chan KY, Chaurasiya SK, Fadel D, Haddad M, Imane T, Jones L, Sheppard AL, Vianya-Estopa M, Walsh K, Woods J, Zeri F, Morgan PB. BCLA CLEAR Presbyopia: Evaluation and diagnosis. Cont Lens Anterior Eye 2024:102156. [PMID: 38641525 DOI: 10.1016/j.clae.2024.102156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.
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Affiliation(s)
- James S Wolffsohn
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom.
| | - David Berkow
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Ka Yin Chan
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong
| | - Suraj K Chaurasiya
- Department of Contact Lens and Anterior Segment, CL Gupta Eye Institute, Moradabad, India; Department of Optometry and Vision Science, CL Gupta Eye Institute, Moradabad, India
| | - Daddi Fadel
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Mera Haddad
- Faculty of Applied Medical Sciences, Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Tarib Imane
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, United States
| | - Lyndon Jones
- Centre for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong; Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Amy L Sheppard
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Marta Vianya-Estopa
- Vision and Hearing Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Karen Walsh
- CooperVision Inc., San Ramon, CA, United States
| | - Jill Woods
- Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Canada
| | - Fabrizio Zeri
- School of Optometry, Health and Life Sciences, Aston University, Birmingham, United Kingdom; University of Milano-Bicocca, Department of Materials Science, Milan, Italy
| | - Philip B Morgan
- Eurolens Research, Division of Pharmacy and Optometry, University of Manchester, United Kingdom
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Gomes JAP, Azar DT, Baudouin C, Bitton E, Chen W, Hafezi F, Hamrah P, Hogg RE, Horwath-Winter J, Kontadakis GA, Mehta JS, Messmer EM, Perez VL, Zadok D, Willcox MDP. TFOS Lifestyle: Impact of elective medications and procedures on the ocular surface. Ocul Surf 2023; 29:331-385. [PMID: 37087043 DOI: 10.1016/j.jtos.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/24/2023]
Abstract
The word "elective" refers to medications and procedures undertaken by choice or with a lower grade of prioritization. Patients usually use elective medications or undergo elective procedures to treat pathologic conditions or for cosmetic enhancement, impacting their lifestyle positively and, thus, improving their quality of life. However, those interventions can affect the homeostasis of the tear film and ocular surface. Consequently, they generate signs and symptoms that could impair the patient's quality of life. This report describes the impact of elective topical and systemic medications and procedures on the ocular surface and the underlying mechanisms. Moreover, elective procedures performed for ocular diseases, cosmetic enhancement, and non-ophthalmic interventions, such as radiotherapy and bariatric surgery, are discussed. The report also evaluates significant anatomical and biological consequences of non-urgent interventions to the ocular surface, such as neuropathic and neurotrophic keratopathies. Besides that, it provides an overview of the prophylaxis and management of pathological conditions resulting from the studied interventions and suggests areas for future research. The report also contains a systematic review investigating the quality of life among people who have undergone small incision lenticule extraction (SMILE). Overall, SMILE refractive surgery seems to cause more vision disturbances than LASIK in the first month post-surgery, but less dry eye symptoms in long-term follow up.
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Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), Sao Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | - Christophe Baudouin
- Quinze-Vingts National Eye Hospital & Vision Institute, IHU FOReSIGHT, Paris, France
| | - Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montréal, Canada
| | - Wei Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | | | - Pedram Hamrah
- Department of Ophthalmology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, UK
| | | | | | | | | | - Victor L Perez
- Foster Center for Ocular Immunology, Duke University Eye Center, Durham, NC, USA
| | - David Zadok
- Shaare Zedek Medical Center, Affiliated to the Hebrew University, School of Medicine, Jerusalem, Israel
| | - Mark D P Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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Sánchez-González MC, Gutiérrez-Sánchez E, Sánchez-González JM, De-Hita-Cantalejo C, Pinero-Rodríguez AM, González-Cruces T, Capote-Puente R. Complications of Small Aperture Intracorneal Inlays: A Literature Review. Life (Basel) 2023; 13:life13020312. [PMID: 36836669 PMCID: PMC9965951 DOI: 10.3390/life13020312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/20/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023] Open
Abstract
Presbyopia can be defined as the refractive state of the eye in which, due to a physiological decrease in the ability to accommodate, it is not possible to sustain vision without fatigue in a prolonged manner, along with difficulty focusing near vision. It is estimated that its prevalence in 2030 will be approximately 2.1 billion people. Corneal inlays are an alternative in the correction of presbyopia. They are implanted beneath a laser-assisted in situ keratomileusis (LASIK) flap or in a pocket in the center of the cornea of the non-dominant eye. The purpose of this review is to provide information about intraoperative and postoperative KAMRA inlay complications in the available scientific literature. A search was conducted on PubMed, Web of Science, and Scopus with the following search strategy: ("KAMRA inlay" OR "KAMRA" OR "corneal inlay pinhole" OR "pinhole effect intracorneal" OR "SAICI" OR "small aperture intracorneal inlay") AND ("complication" OR "explantation" OR "explanted" OR "retired"). The bibliography consulted shows that the insertion of a KAMRA inlay is an effective procedure that improves near vision with a slight decrease in distance vision. However, postoperative complications such as corneal fibrosis, epithelial iron deposits, and stromal haze are described.
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Affiliation(s)
| | | | | | | | | | - Timoteo González-Cruces
- Department of Anterior Segment, Cornea and Refractive Surgery, Hospital La Arruzafa, 14012 Cordoba, Spain
| | - Raúl Capote-Puente
- Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain
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Wolffsohn JS, Davies LN, Sheppard AL. New insights in presbyopia: impact of correction strategies. BMJ Open Ophthalmol 2023. [DOI: 10.1136/bmjophth-2022-001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Presbyopia occurs when the physiologically normal age-related reduction in the eyes focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual’s requirements. Hence, it is more about the impact it has on an individual’s visual ability to function in their environment to maintain their lifestyle than a measured loss of focusing ability. Presbyopia has a significant impact on an individual’s quality of life and emotional state. While a range of amelioration strategies exist, they are often difficult to access in the developing world and prescribing is generally not optimal even in developed countries. This review identified the need for a standardised definition of presbyopia to be adopted. An appropriate battery of tests should be applied in evaluating presbyopic management options and the results of clinical trials should be published (even if unsuccessful) to accelerate the provision of better outcomes for presbyopes.
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Moshirfar M, Henrie MK, Payne CJ, Ply BK, Ronquillo YC, Linn SH, Hoopes PC. Review of Presbyopia Treatment with Corneal Inlays and New Developments. Clin Ophthalmol 2022; 16:2781-2795. [PMID: 36042913 PMCID: PMC9420445 DOI: 10.2147/opth.s375577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Presbyopia may represent the largest segment of refractive errors that is without an established and effective refractive surgery treatment. Corneal Inlays are materials (synthetic or allogenic) implanted in the stroma of patients’ corneas to improve presbyopia. These inlays, introduced into the United States in 2015 via the small-aperture corneal inlay (KAMRATM, SightLife Surgical/CorneaGen, Seattle, Washington, United States), were met with an initial wave of enthusiasm. Subsequent models like the shape-changing corneal inlay (RAINDROPTM, Revision Optics, Lake Forest, California, United States) offered excellent results for patients, but longer-term research raised questions about patient safety. At the time of this article, no synthetic corneal inlays are available in the United States for the correction of presbyopia. Other options for presbyopia correction include allograft corneal inlays, trifocal synthetic corneal inlays, pharmacologic therapies, scleral incisions or additive techniques and PresbyLASIK. Presently, allograft inlays consist of corneal lenticules removed from patients undergoing Small Incision Lenticule Extraction (SMILE). We will review corneal inlays and other alternative procedures that may provide effective and predictable treatments for patients with presbyopia.
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Affiliation(s)
- Majid Moshirfar
- HDR Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
- Correspondence: Majid Moshirfar, HDR Research Center, Hoopes Vision, 11820 State St, Draper, UT, USA, Email
| | | | - Carter J Payne
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Briana K Ply
- HDR Research Center, Hoopes Vision, Draper, UT, USA
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