 Presbyopia
is the aging change in the lens of the eye that
occurs during the early 40's, causing a need for
reading glasses. It happens to everyone, and the
"cure" for presbyopia is the holy grail
of refractive surgeons and patients everywhere.
People who are nearsighted are able to see near,
even if they are older and have presbyopia. That
is why if you are nearsighted you can take your
glasses or contacts off and see close up, even
if you are in your 50's. Monovision uses this
fact to allow you to see up close without glasses
after surgery, however there are tradeoffs with
monovision.
A true surgical reversal of presbyopia without
doing monovision is being worked on. There are
two basic approaches to this type of treatment-the
first tries to restore natural focusing ability
to the lens, and the second uses a principle called
multifocality to achieve near vision.
Restoring natural focusing ability to the lens
is being attempted with a procedure called Surgical
Reversal of Presbyopia, or SRP. SRP involves
the placement of tiny implants in the sclera (the
white part of the eye), similar to putting a belt
through belt loops. These implants are known as
Scleral Expansion Bands. Results
at this point are mixed-some patients get some
effect and many others get no effect.
 Other
procedures along the same vein include Laser
Presbyopia Reversal (LAPR) surgery with the
Surgilight laser, an infrared laser which ablates
sclera. A non-laser form of this technique is
called Anterior
Ciliary Sclerotomy, or ACS. ACS
results have been poor to date, but some surgeons
are working on a modification of the technique,
using spacers inside
the incisions to prevent the regression of
effect that is typically seen.
Some lens implants originally designed for use
in cataract surgery are being modified to try
to allow for reversal of presbyopia. Accommodative
IOLs are implants with tiny hinges that allow
movement of the lens inside the eye, which optically
can allow for some near vision.
Multifocal approaches to presbyopia include placement
of multifocal intraocular lenses like the AMO
Array lens, or small circular implants placed
in the cornea either in a pocket created, or under
a flap. Other work being done focuses on multifocal
cornea ablations using LASIK or PRK, to attempt
to create a "bifocal" effect in the
cornea.
 Accommodative
IOLs coming a long way
Anterior ciliary sclerotomy and the correction
of presbyopia
Ciliary
sclerotomy with the insertion of silicone expansion
plug
Study:
Sclerotomy not effective for presbyopia, can cause
complications
Laser
treatment designed to reverse presbyopia
Monovision,
implants offer choices for presbyopia correction
SEBs
can be inconsistent, unpredictable, study suggests
Presbyopia
technologies include IOL and scleral approaches
Presbyopia:
Exploring the final frontier
Multizone
laser treatment can be used to correct presbyopia
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