Psychometric evaluation of the near activity visual questionnaire presbyopia (NAVQ-P) and additional patient-reported outcome items

BACKGROUND

The Near Visual Acuity Questionnaire Presbyopia (NAVQ-P) is a patient-reported outcome (PRO) measure that was developed in a phakic presbyopia population to assess near vision function impacts. The study refined and explored the psychometric properties and score interpretability of the NAVQ-P and additional PRO items assessing near vision correction independence (NVCI), near vision satisfaction (NVS), and near vision correction preference (NVCP).

METHODS

This was a psychometric validation study conducted using PRO data collected as part of a Phase IIb clinical trial (CUN8R44 A2202) consisting of 235 randomized adults with presbyopia from the US, Japan, Australia, and Canada. Data collected at baseline, week 2, and months 1, 2, and 3 during the 3-month trial treatment period were included in the analyses to assess item (question) properties, NAVQ-P dimensionality and scoring, reliability, validity, and score interpretation.

RESULTS

Item responses were distributed across the full response scale for most NAVQ-P and additional PRO items. Confirmatory factor analysis supported the pre-defined unidimensional structure and calculation of a NAVQ-P total score as a measure of near vision function. Item deletion informed by item response distributions, dimensionality analyses, item response theory, and previous qualitative findings, including clinical input, supported retention of 14 NAVQ-P items. The 14-item NAVQ-P total score had excellent internal consistency (α = 0.979) and high test-retest reliability (Intraclass Correlation Coefficients > = 0.898). There was good evidence of construct-related validity for all PROs supported by strong correlations with concurrent measures. Excellent results for known-groups validity and ability to detect change analyses were also demonstrated. Anchor-based and distribution-based methods supported interpretation of scores through generation of group-level and within-individual estimates of meaningful change thresholds. A meaningful within-patient change in the range of 8-15-point improvement on the NAVQ-P total score (score range 0-42) was recommended, including a more specific responder definition of 10-point improvement.

CONCLUSIONS

The NAVQ-P, NVCI, and NVS are valid and reliable instruments which have the ability to detect change over time. Findings strongly support the use of these measures as outcome assessments in clinical/research studies and in clinical practice in the presbyopia population.

Content development for a new item-bank for measuring multifocal contact lens performance

BACKGROUND

Presbyopia is an age-related condition that causes a decreased ability to focus on nearby objects. Multifocal contact lenses are commonly used to address this issue. However, there seems to be a notable dissatisfaction among multifocal contact lens wearers. The absence of a reliable instrument to measure the patient's perspective, despite the widespread use of this method, highlights the need for further research in this area.

OBJECTIVE

The objective of this study is to develop an item-bank integrating all domains necessary to assess the patient's perspective on multifocal contact lens performance, offering a comprehensive measure. The item-bank will ensure a high level of content validity, be self-administered, and will initially be available in Spanish. The aim of this tool is to serve as a valuable resource for research and optometric clinics, facilitating the follow-up of patients with presbyopia who wear multifocal contact lenses or those who are newly starting to use them.

METHODOLOGY

The MCL-PRO item bank, followed a systematic and step-wise inductive approach to gather information, following the recommendations outlined in the COSMIN guidelines and similar studies. The process involved the following steps: (1) Literature review and relevant existing items identification (2) Social media review, (3) Semi-structured focus groups, (4) performing qualitative analysis, (5) refining and revising the items, and (6) generating the content of the item bank.

RESULTS

A total of 575 items were included in the item-bank hosted under 8 different domains that were found to be important for presbyopic population: visual symptoms (213), activity limitation (111), ocular symptoms (135), convenience (36), emotional well-being (33), general symptoms (16), cognitive issues (21) and economic issues (10).

CONCLUSION

The item-bank created has followed standardised methodology for its development and encloses all the aspects for MCL performance evaluation from patients perspective.

Comparison of the new self-contained darkroom refractive screener versus table-top autorefractor and cycloplegia retinoscopy in detecting refractive error

PURPOSE

By comparing the results of the new self-contained darkroom refractive screener (YD-SX-A) versus table-top autorefractor and cycloplegic retinoscopy, to evaluate the performance of the YD-SX-A in detecting refractive error in children and adolescents and then judge whether it can be used in refractive screening.

METHODS

Cross-sectional study. 1000 participants between the ages of 6 and 18 who visited the Optometry Center of the People's Hospital of Guangxi Zhuang Autonomous Region from June to December 2022 were selected. First, participants were instructed to measure their diopter with a table-top autorefractor (Topcon KR8800) and YD-SX-A in a noncycloplegic setting. After cycloplegia, they were retinoscopy by a professional optometrist. The results measured by three methods were collected respectively. To avoid deviation, only the right eye (1000 eyes) data were used in the statistical analysis. The Bland-Altman plots were used to evaluate the agreement of diopters measured by the three methods. The receiver operating characteristic (ROC) curves was used to analysis effectiveness of detecting refractive error of YD-SX-A.

RESULTS

The average age of participants was 10.77 ± 3.00 years, including 504 boys (50.4%) and 496 girls (49.6%). When YD-SX-A and cycloplegia retinoscopy (CR) were compared in the myopia group, there was no statistical difference in spherical equivalent (SE) (P > 0.05), but there was a statistical difference in diopter spherical (DS) and diopter cylinder (DC) (P < 0.05). Comparing the diopter results of Topcon KR8800 and CR, the difference between each test value in the myopia group was statistically significant (P < 0.05). In the hyperopia group, the comparison between YD-SX-A and CR showed no statistically significant differences in the DC (P > 0.05), but there were significant differences in the SE and DS (P < 0.05). In the astigmatism group, the SE, DS, and DC were statistically different, and the DC of YD-SX-A was lower than that of CR and Topcon KR8800. Bland-Altman plots indicated that YD-SX-A has a moderate agreement with CR and Topcon KR8800. The sensitivity and specificity of YD-SX-A for detecting myopia, hyperopia and astigmatism were 90.17% and 90.32%, 97.78% and 87.88%, 84.08% and 74.26%, respectively.

CONCLUSION

This study has identified that YD-SX-A has shown good performance in both agreement and effectiveness in detecting refractive error when compared with Topcon KR8800 and CR. YD-SX-A could be a useful tool for large-scale population refractive screening.

Social Media Listening to Understand the Lived Experience of Presbyopia: Systematic Search and Content Analysis Study

BACKGROUND

Presbyopia is defined as the age-related deterioration of near vision over time which is experienced in over 80% of people aged 40 years or older. Individuals with presbyopia have difficulty with tasks that rely on near vision. It is not currently possible to stop or reverse the aging process that causes presbyopia; generally, it is corrected with glasses, contact lenses, surgery, or the use of a magnifying glass.

OBJECTIVE

This study aimed to explore how individuals used social media to describe their experience of presbyopia with regard to the symptoms experienced and the impacts of presbyopia on their quality of life.

METHODS

Social media sources including Twitter, forums, blogs, and news outlets were searched using a predefined search string relating to symptoms and impacts of presbyopia. The data that were downloaded, based on the keywords, underwent manual review to identify relevant data points. Relevant posts were further manually analyzed through a process of data tagging, categorization, and clustering. Key themes relating to symptoms, impacts, treatment, and lived experiences were identified.

RESULTS

A total of 4456 social media posts related to presbyopia were identified between May 2017 and August 2017. Using a random sampling methodology, we selected 2229 (50.0%) posts for manual review, with 1470 (65.9%) of these 2229 posts identified as relevant to the study objectives. Twitter was the most commonly used channel for discussions on presbyopia compared to forums and blogs. The majority of relevant posts originated in Spain (559/1470, 38.0%) and the United States (426/1470, 29.0%). Of the relevant posts, 270/1470 (18.4%) were categorized as posts written by individuals who have presbyopia, of which 37 of the 270 posts (13.7%) discussed symptoms. On social media, individuals with presbyopia most frequently reported experiencing difficulty reading small print (24/37, 64.9%), difficulty focusing on near objects (15/37, 40.5%), eye strain (12/37, 32.4%), headaches (9/37, 24.3%), and blurred vision (8/37, 21.6%). 81 of the 270 posts (30.0%) discussed impacts of presbyopia-emotional burden (57/81, 70.4%), functional or daily living impacts (46/81, 56.8%), such as difficulty reading (46/81, 56.8%) and using electronic devices (21/81, 25.9%), and impacts on work (3/81, 3.7%).

CONCLUSIONS

Findings from this social media listening study provided insight into how people with presbyopia discuss their condition online and highlight the impact of presbyopia on individuals' quality of life. The social media listening methodology can be used to generate insights into the lived experience of a condition, but it is recommended that this research be combined with prospective qualitative research for added rigor and for confirmation of the relevance of the findings.

Vision with different presbyopia corrections simulated with a portable binocular visual simulator

Presbyopes can choose today among different corrections to provide them with functional vision at far and near, and the outcomes and patient satisfaction depend on the selection. In this study, we present a binocular and portable vision simulator, based on temporal multiplexing of two synchronized tunable lenses allowing see-through and programmable visual simulations of presbyopic corrections. Seventeen binocular corrections were tested: 3 Monofocal (Far, Intermediate, Near), 4 Simultaneous Vision (bifocal, trifocal), 2 Monovision (far and near in either eye) and 8 Modified Monovision corrections (Simultaneous vision in one eye, Monofocal in the other eye). Perceived visual quality was assessed through the simulated corrections in 8 cyclopleged subjects who viewed a composite realistic visual scene with high contrast letters and a landscape at far (4 m) and a high contrast text at intermediate (66 cm) and near (33 cm) distances. Perceptual scores were obtained on a scale of 0 to 5 (low to high perceived quality). Perceptual preference was assessed by judging 36 random image pairs (6 repetitions) viewed through 9 binocular presbyopic corrections using two-interval forced choice procedures. The average score, across far and near distances, was the highest for Monovision (4.4±0.3), followed by Modified Monovision (3.4±0.1), Simultaneous Vision (3.0±0.1) and Monofocal corrections (2.9±0.2). However, the mean difference between far and near was lower for Simultaneous Vision and Monovision (0.4±0.1 PS) than Modified Monovision (1.8±0.7) or monofocal corrections (3.3±1.5). A strong significant correlation was found between the perceptual scores and the percentages of energy in focus, for each correction and distance (R = 0.64, p<0.0001). Multivariate ANOVA revealed significant influence of observation distances (p<10-9) and patients (p = 0.01) on Perceptual Score. In conclusion, we have developed a binocular portable vision simulator that can simulate rapidly and non-invasively different combinations of presbyopic corrections. This tool has applications in systematic clinical evaluation of presbyopia corrections.

Rapid Vision Correction by Special Operations Forces

BACKGROUND

This report describes a rapid method of vision correction used by Special Operations Medics in multiple operational engagements.

METHODS

Between 2011 and 2015, Special Operations Medics used an algorithm- driven refraction technique. A standard block of instruction was provided to the medics, along with a packaged kit. The technique was used in multiple operational engagements with host nation military and civilians. Data collected for program evaluation were later analyzed to assess the utility of the technique.

RESULTS

Glasses were distributed to 230 patients with complaints of either decreased distance or near (reading). Most patients (84%) with distance complaints achieved corrected binocular vision of 20/40 or better, and 97% of patients with near-vision complaints achieved corrected near-binocular vision of 20/40 or better. There was no statistically significant difference between the percentages of patients achieving 20/40 when medics used the technique under direct supervision versus independent use.

CONCLUSION

A basic refraction technique using a designed kit allows for meaningful improvement in distance and/or near vision at austere locations. Special Operations Medics can leverage this approach after specific training with minimal time commitment. It can serve as a rapid, effective intervention with multiple applications in diverse operational environments.

PRESBYOPIA OPTOMETRY METHOD BASED ON DIOPTER REGULATION AND CHARGE COUPLE DEVICE IMAGING TECHNOLOGY

With the development of photoelectric technology and single-chip microcomputer technology, objective optometry, also known as automatic optometry, is becoming precise. This paper proposed a presbyopia optometry method based on diopter regulation and Charge Couple Device (CCD) imaging technology and, in the meantime, designed a light path that could measure the system. This method projects a test figure to the eye ground and then the reflected image from the eye ground is detected by CCD. The image is then automatically identified by computer and the far point and near point diopters are determined to calculate lens parameter. This is a fully automatic objective optometry method which eliminates subjective factors of the tested subject. Furthermore, it can acquire the lens parameter of presbyopia accurately and quickly and can be used to measure the lens parameter of hyperopia, myopia and astigmatism.

Evaluating the short-term results of KAMRA inlay implantation using real-time optical coherence tomography-guided femtosecond laser technology

PURPOSE

To evaluate the outcomes from using real-time optical coherence tomography (OCT)-guided femtosecond laser technology for pocket creation for KAMRA inlay (Acufocus, Inc., Irvine, CA) implantation surgery.

METHODS

One hundred fifty-one eyes underwent KAMRA inlay implantation using the real-time OCT-guided femtosecond laser for pocket creation. All patients had a history of prior LASIK. Uncorrected distance visual acuity, corrected distance visual acuity, uncorrected near visual acuity, corrected near visual acuity, and manifest refraction spherical equivalent were evaluated preoperatively and postoperatively. The follow-up period was 3 months.

RESULTS

Mean manifest refraction spherical equivalent, uncorrected distance visual acuity, and uncorrected near visual acuity changed from -0.18 ± 0.33 to -0.95 ± 0.64, 20/16 to 20/20, and J8 to J2, respectively. Corrected distance visual acuity and corrected near visual acuity remained stable before and after KAMRA inlay implantation, 20/12 and J1, respectively.

CONCLUSIONS

Using real-time OCT-guided femtosecond laser technology increases the safety and accuracy of corneal KAMRA inlay implantation surgery with a history of prior LASIK with excellent visual and refractive outcomes.

[Regularities of structural and functional visual system changes in patients with myopic refraction and presbyopia]

Two age groups of 57 patients with noncomplicated low or moderate myopia were examined to reveal the regularities of structural and functional visual system changes in patients with myopic refraction and presbyopia. Characteristics of visual impression, anatomic and physiologic parameters were studied. Presbyopia development in patients with myopic refraction was found to occur on the background of significant changes in anatomic proportions and optic parameters of the eye, decrease of functional capability of visual system and development of abnormal functional system of visual perception. The key mechanisms of presbyopia development in myopia besides the accommodation decrease are pupil dysfunction and binocular interactions disintegration i. e. all the near vision reflex components.

[Consensus recommendations for the assessment of fitness to drive in cognitively impaired patients]

Memory Clinics provide evidence based diagnosis and treatment of dementia. Whenever a diagnosis of dementia is made, it is important to inform the patients about the possible impact of dementia on driving. Patients and their next of kin require competent advice whenever this difficult question is addressed and the mobility desire and the risks related to driving need to be carefully weight up. The time of diagnosis does not necessarily equate to the time when a person with dementia becomes an unsafe driver. The cause and severity of dementia, comorbidities and the current medication need to be carefully taken into account for this decision. On behalf of the association of the Swiss Memory Clinics, a group of experts has developed recommendations to assess fitness to drive in cognitively impaired older adults.

[Presbyopia correction using accommodating intraocular lens]

Clinical results of binocular implantation of intraocular lens (IOL) Crystalens HD500 are assessed in 25 patients (mean age 62, 7 +/- 2,6 years) without severe intraocular diseases. Accommodating capacity of this IOL was showed to be provided by movement along the optic axis and not to exceed 1,0-1,5D, that is not enough to compensate for accommodation amplitude required for comfortable reading without spectacles. Preoperative discussion of lens features with patients, planning of aim-refraction considering minimonovision technique, precise performance of all implantation stages for this IOL model are essential for high visual results and complete satisfaction of a patient.

Improved near vision with ready-made spectacles for presbyope in Chachoengsao province

The Objective of the present research was to study the improvement of near vision with ready-made spectacles for presbyope in Chachoengsao province. Retrospective cross-sectional analytic study was conducted in 309 volunteers at Sanamchaiket district whose ages were 35 years and above. Visual acuity was measured in presbyopic patients, and then ready-made spectacles were given as a trial. Visual acuity of near distance was measured at the time before and after correction with ready-made spectacles. Aim was to achieve the visual acuity of 20/50 or better. The number of volunteers was 129. Out of these, 96.12 percent (124 of 129) achieved the aim of the visual acuity (124 of 129). In conclusion, ready-made spectacles were effective in correcting near vision for presbyope at any group of ages and both sexes in Chachoeungsao province. If the difference of refractive error between both eyes was greater than +1.25 Diopter ready-made spectacles were ineffective.

Non-verbal visual reinforcement affects speech audiometry in the elderly

The purpose of this study was to investigate how non-verbal visual reinforcement provided by the audiologist during speech testing influences performance in the elderly. Thirty-two volunteers with age-related hearing loss with or without dual sensory-impairment (DSI), were administered a speech audiometry test in which they repeated lists of ten disyllabic words in two different conditions, namely with and without visual reinforcement. In the conditions of "with visual reinforcement", the tester provided non-verbal cues to acknowledge the response of each participant. The "visual reinforcement" condition did not apparently provide any significant variation in the results. However, when we considered the group of patients without DSI, the non-verbal "visual reinforcement" resulted in better scores (p < 0.001). Non-verbal visual reinforcement may influence speech audiometry results in the elderly. During speech testing of elderly people with age-related hearing loss, audiologists should always remember to administer visual reinforcement to the patients in order to remove a possible confounding factor from audiological evaluation.

Uncorrected refractive errors, presbyopia and spectacle coverage: results from a rapid assessment of refractive error survey

PURPOSE

To investigate the prevalence of uncorrected refractive errors, presbyopia and spectacle coverage in subjects aged 15-50 years using rapid assessment methodology in the Mahabubnagar district of Andhra Pradesh, India.

METHODS

A population-based cross sectional study was conducted using cluster random sampling to enumerate 3,300 subjects from 55 clusters. Unaided, aided and pinhole visual acuity was assessed using a LogMAR chart at a distance of 4 meters. Near vision was assessed using N notation chart. Uncorrected refractive error was defined as presenting visual acuity worse than 6/12 but improving to at least 6/12 or better on using a pinhole. Presbyopia is defined as binocular near vision worse than N8 in subjects aged more than 35 years with binocular distance visual acuity of 6/12 or better.

RESULTS

Of the 3,300 subjects enumerated from 55 clusters, 3,203 (97%) subjects were available for examination. Of these, 1,496 (46.7%) were females and 930 (29%) were > or = 40 years. Age and gender adjusted prevalence of uncorrected refractive errors causing visual impairment in the better eye was 2.7% (95% CI, 2.1-3.2%). Presbyopia was present in 690 (63.7%, 95% CI, 60.8-66.6%) subjects aged over 35 years. Spectacle coverage for refractive error was 29% and for presbyopia it was 19%.

CONCLUSIONS

There is a large unmet need for refractive correction in this area in India. Rapid assessment methods are an effective means of assessing the need for services and the impact of models of care.

Extended depth of focus contact lenses for presbyopia

The purpose of this Letter is to design, develop, fabricate, and test in clinical trials a new (to our knowledge) type of contact lenses that provides simultaneous near and distance focused vision for presbyopic subjects, including those with up to 2.00 diopters (D) of regular/irregular astigmatism, as an alternative to multifocal contact lenses. The purpose is obtained by generating an optical pattern on the front surface of contact lenses, capable of extending the depth of focus of lenses by 3.00 D with high visual contrast. The pattern was fabricated on top of contact lenses and tested by the use of an eye simulation as well as in clinical trials. Use of the extended depth of focus contact lens enabled patients to achieve good visual acuity and contrast sensitivity for both distance and near vision without compromising the energy distribution or the visual fields.

IOL Tetraflex, KH 3500--presbyopia treatment

INTRODUCTION

Presbyopia is a loss of accommodative capacity of the eye determined by age. The possible solutions for its treatment are spectacle correction (mono-, bi- or multifocal), multifocal contact lenses, conductive keratoplasty, excimer laser surgery and surgical solution - CLE.

AIM

Four-year experience with using LOL Tetraflex KH 3500 by Lenstec.

MATERIAL AND METHODOLOGY

Between 2005 and 2009, 71 eyes of 35 patients with the average age of 52 were operated at the private ophthalmological clinic 3F Microsurgery of the Eye in Kosice. The patients were selected by strict indication criteria recommended by the producer. We have evaluated the ability of the implanted lens to substitute for the presbyopic correction. The subjective criterion of patient's evaluation was the expression of content in common life situations on the scale of 1 to 10. The objective evaluation was constituted by the measurement of the accommodation width, the presence of PCO, its solution by means of YAG capsulotomy and the subsequent influence on the pseudo accommodative capacity of the lense.

RESULTS

92% of operated patients expressed their complete satisfaction with the surgery results. By objective accommodometer measurement, we have identified the average accommodation width of +1,5 dioptres on the operated eyes. The presence of PCO was discovered in 42,2% cases. All cases were treated by YAG Capsulotomy. By further observation we have tried to determine the influence of YAG Capsulotomy on the accommodation width and pseudo accommodative capacity of the eye.

CONCLUSION

The selection and use of TETRAFLEX lens is an appropriate alternative to presbyopia treatment with suitable patients.

Accommodative response in pre-presbyopes with visual impairment and its clinical implications

PURPOSE

There are isolated reports that accommodative response is reduced in some populations with low vision. The purpose of this study was to measure accommodative response in a wider range of pre-presbyopes with visual impairment and to examine what factors may affect accommodation among the low vision population.

METHODS

Accommodative responses for accommodative demands between 4 and 10 D were measured with dynamic retinoscopy in 21 subjects with low vision due to a variety of disorders and in 40 control subjects, aged 3 to 35 years. The control subjects were divided into age groups of 3 to 5, 6 to 10, 11 to 26, and 27 to 35 years, and the response of each subject with low vision was compared against the age-matched control group. The slope of the accommodative function and the mean error of the accommodative response were also calculated.

RESULTS

Eighty-six percent of the subjects with low vision showed responses that were outside the 95% range of normal. The deficit increased with increasing accommodative demand. Reduced accommodation was not predicted by age, visual acuity, presence of nystagmus, refractive error or time of onset of the disorder. The results show that the accommodation errors are often greater than predicted by increased depth of focus due to poor visual acuity.

CONCLUSIONS

It seems likely that accommodative response is based on many factors that may be present in an eye with low vision, which interact in a complex fashion.

Is randomisation necessary for measuring defocus curves in pre-presbyopes?

PURPOSE

Defocus curves are used to evaluate the subjective range of clear vision of presbyopic corrections such as in eyes implanted with accommodating intraocular lenses (IOLs). This study determines whether letter sequences and/or lens presentation order ought to be randomised when measuring defocus curves.

METHODS

Defocus curves (range +2.00DS to -2.00DS) were measured on 18 pre-presbyopic subjects (mean age 24.1+/-4.2 years) for six combinations of sequential or randomised positive or negative lens progression and non-randomised or randomised letter sequences. The letters were presented on a computerised logMAR chart at 6m.

RESULTS

Overall there was a statistically significant difference between the six combinations (ANOVA, p<0.05) attributable to the combination of non-randomised letters with non-randomised lens progression from negative to positive defocus (p<0.01). There was no statistically significant difference in defocus curve measurements if both letters and lens order were randomised compared to if only one of these variables was randomised (p>0.05). Non-randomised letters, with a sequential lens progression from negative to positive, was significantly different to all other combinations when compared individually (Student's T-test, p<0.003 on all comparisons), and was confirmed as the sole source of the overall significant difference. There was no statistically significant difference if both lens presentation order and letter sequences were randomised compared to if only one or the other of these variables was randomised.

CONCLUSION

Non-randomised letters and non-randomised lens progression on their own did not affect the subjective amplitude of accommodation as measured by defocus curves, although their combination should be avoided.

[Refraction and accommodation]

The main purpose of ophthalmology is to improve the quality of vision by the recovery of visual function. Visual acuity, among the visual functions, is the most important factor. Decreased far vision is caused mainly by refractive errors, while decreased near vision is caused by accommodative insufficiency, especially presbyopia. REFRACTIVE ERRORS: The development of myopia may be influenced by both polygenic and environmental factors. Investigation of the mechanism of myopia has progressed based on the experimental animal models of myopia. The conventional treatments for refractive errors is spectacles or contact lenses, and new treatment includes phakic IOL, orthokeratology, and refractive surgery. There are also newly designed types of equipment to assess refraction and refractive elements. ACCOMMODATIVE INSUFFICIENCY: Presbyopia is mainly corrected using multifocal or progressive power spectacle lenses. Nowadays, bifocal and multifocal contact lenses and sometimes surgical treatment are used for presbyopia. Equipment for asthenopia has also been developed.

PresbyLASIK

Presbyopia represents the most common refractive error. There is currently no surgical treatment for presbyopia, which is effective, reliable, and safe. Excimer laser surgery has become a routine procedure for the correction of myopia, hyperopia, and astigmatism for years. Various treatment strategies for presbyopia have been brought forward using the excimer lasers. Besides monovision, creation of a multifocal cornea represents an attractive option. This procedure is also called "PresbyLASIK." Different ablation profiles to form a multifocal cornea are reviewed here and first clinical results are summarized."PresbyLASIK" is a new, interesting treatment strategy, with a huge potential for the future. At the present it should be used in controlled studies only because of some unsolved questions.

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.