December 2019


Examining presbyopia treatments

By Vance Thompson, MD
EyeWorld Refractive Editor

Presbyopia is something we deal with daily. We educate patients on its natural course. We dream of restoring accommodation. We think about noninvasive ways to delay it. We create it through cataract surgery in patients who still have some accommodative amplitude when we take them to plano in each eye with a monofocal implants. We mitigate for it through optical devices, corneal laser monovision, pseudophakic monofocal monovision, and pseudophakic multifocal vision. With all the attention given to the correction of the one refractive error that happens with the greatest frequency, it is a great pleasure to see such an amazing review of options, like the one the doctors and writers have put together for this issue of EyeWorld’s In Focus series, dedicated to presbyopia.
In the first feature, Robert Cionni, MD, Eric Donnenfeld, MD, Kerry Solomon, MD, and Elizabeth Yeu, MD, discuss how our country’s first trifocal, the PanOptix IOL from Alcon, is a welcome addition to our lens replacement. We all understand that patients have three main distances to function at after cataract surgery: distance, intermediate, and near. For those who desire spectacle independence, a trifocal implant is intuitive. Plus, eye dominance becomes less of an issue when implanting a trifocal in each eye. These doctors do a wonderful job of educating us on the optical characteristics of a trifocal and providing tips on how to maximize patient success with them.
In the second feature, John Doane, MD, Stephen Slade, MD, Kevin Waltz, MD, and William Wiley, MD, share their experience with the world’s first optic that has the ability to adjust power inside the patient’s eye: the Light Adjustable Lens from RxSight. We all know that our implant calculations are not perfect, because the final effective lens position, incisional healing, and posterior corneal astigmatism can all lead to us saying at 3 weeks postop “I wish I would have known their healing process; I would have put in a different power implant.” What is
exciting about Light Adjustable Lens technology is the fact that at that 3-week postoperative visit we simply can start to change the power of the implant to that dream power. It is a revolutionary concept, and for presbyopia monovision done this precisely, can be very effective. Thank you doctors for sharing your tips on how to optimize this exciting technology that will bring refractive enhancements to all cataract surgeons.
In the third feature Jorge Alió, MD, PhD, John Hovanesian, MD, Michael Korenfeld, MD, Veronica Vargas, MD, and Felipe Vejarano, MD, give us a beautiful review of the pharmacologic treatment of presbyopia that is coming in our near future. To be able to use our body’s own anatomy—the crystalline lens and pupil—for treating presbyopia is so exciting. The awareness these various pharmacologic drops will bring to patients will help so many and increase awareness and understanding of what presbyopia truly is. I believe this will help, someday with surgical discussions when patients have a thorough understanding of their own optical system and how the drops helped them for a certain period of time.
In the fourth feature, Brandon Baartman, MD, Lance Kugler, MD, and Luke Rebenitsch, MD, teach us about corneal refractive monovision, also known as blended vision. This can be very successful in early presbyopes with clear lenses and their tips such as contact lens testing preoperatively are so helpful.
As a refractive cornea, phakic IOL, and lens surgeon, I, like many of you, deal with presbyopia discussions in over half of my clinic and surgery journey. To get a review like this from this group of world experts is such gift. Again, thank you to the doctors and writers of these great articles and thank you to EyeWorld for featuring such a relevant topic to today’s refractive and cataract surgeon.

Examining presbyopia treatments Examining presbyopia treatments
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