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Advances in Presbyopia-Correcting Treatments for Patients

mConsent

November 28, 2023

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Presbyopia, the age-related hardening of the crystalline lens that gradually impacts every patient by reducing near and intermediate focusing ability, has an expanding arsenal of advanced treatment options to address this extremely common vision condition.

In this blog, we will explore the latest technologies and techniques available for correcting presbyopia. 

By leveraging these emerging solutions, optometrists can find the optimal treatment approaches for each patient based on their specific degree of presbyopia progression and visual lifestyle needs.

From advanced intraocular lenses to innovative contact lens designs, presbyopia-correcting treatments are now better and more varied than ever.

We are well-equipped as eye care professionals to analyze all the considerations and identify the ideal vision correction modalities for each individual patient.

The following sections will provide an in-depth look at the newest presbyopia-correcting options available, including the advantages and potential limitations of each approach.

Our goal is to arm optometrists with the knowledge needed to have informed discussions with presbyopic patients about the full range of solutions for managing this common visual condition.

By crafting a personalized treatment plan leveraging the latest advancements, we can ensure every patient achieves their best possible vision at any age and stage of presbyopia progression.

1. Multifocal and Accommodating IOLs

Cataract surgery with multifocal intraocular lens (IOL) implantation allows patients to achieve excellent vision at all distances by incorporating near, intermediate, and distance focal points into one lens.

The latest generation of multifocal IOLs utilize improved diffractive and refractive optics to optimize light distribution between focal points. This provides better intermediate focus and reduced side effects like halos and glare that previously limited universal adoption. 

Accommodating IOLs use hinged optics that shift position within the eye with ciliary muscle contractions, enabling some degree of natural, pseudo-accommodation.

Results vary greatly by patient anatomy and ciliary muscle function, but can restore functional near and intermediate vision following cataract surgery without requiring glasses or contacts. As optometrists, we can have in-depth discussions on IOL options to set proper patient expectations.

2.Presbyopia-Correcting Contact Lenses

 

For earlier onset presbyopia patients still requiring distance vision correction, specialized multifocal soft contact lenses address the loss of reading focus while providing sharp distance acuity.

Center-near, center-distance, and zonal progressive designs utilize aspheric, bifocal, and multifocal optics to enable seamless transition between focal points.

Advanced contact lens fitting techniques like topography-guided scleral lens designs can maximize visual quality and comfort.

As optometrists skilled in specialty contact lens fitting, we can offer these presbyopia-correcting lenses to suitable patients.

3.Corneal Inlays

Though not yet widely adopted, corneal inlays implanted inside the cornea have potential for certain patients.

These ultra-thin devices change corneal shape and depth of field to improve near and intermediate vision without significantly impacting distance vision. The Kamra inlay is the first FDA-approved model.

However, potential side effects like halos, glare, and contrast reduction still limit widespread use. Ongoing advances in surgical techniques and next-generation inlay designs aim to make them more viable options in the future. We will continue monitoring improvements in this area.

4.Corneal Refractive Therapy

 

Corneal refractive therapy (CRT) uses custom rigid contact lenses worn overnight to temporarily reshape the cornea, reducing low to moderate hyperopia and presbyopia.

The cornea retains an aspheric profile during the day after lens removal, providing improved unaided near and intermediate visual focus. 

This non-invasive and reversible treatment can benefit presbyopia patients with up to +1.50D of hyperopia. As specialists in specialty lens fitting, we can determine candidate suitability and maximize outcomes.

5.Laser Vision Correction

Laser vision correction techniques like monovision and small-incision lenticule extraction (SMILE) allow manipulation of the corneal profile to induce minor monovision.

By slightly reducing distance vision in one eye, depth of field increases to provide enhanced near focus. 

Though not as precise as multifocal treatments, it can provide a pseudo-monovision solution for presbyopia. As optometrists, we can discern proper candidacy through refractive and lifestyle analysis.

6.Pharmaceutical Solutions

Pharmaceutical Solutions

Pharmaceutical treatments to temporarily improve near focus are in development. Eye drops containing lipoic acid show particular promise in clinical trials, with ongoing research on optimal dosing and delivery.

Low-dose pilocarpine also provides modest near vision improvement by contracting the ciliary muscle. Additional presbyopia-treating drug therapies are in the process of being developed.

Conclusion

The management of presbyopia has advanced remarkably, with today's treatment options being more varied and effective than ever before.

As optometrists with specialized expertise in areas like contact lens fitting, IOLs, and laser vision correction, you now have an extensive toolkit to address this ubiquitous vision condition.

By leveraging the latest presbyopia-correcting contact lenses, IOL technologies, corneal procedures, and potential pharmaceutical solutions, you can find the optimal treatment approaches for each individual based on their specific visual and lifestyle needs.

The future continues to look bright when it comes to enhancing and expanding management capabilities for this common age-related decline in visual focus.

 
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