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Presbyopia

Presbyopia. Walter Huang, OD Yuanpei University Department of Optometry. Definition. Latin definition Presbyopia = “old man’s eye” . Definition. Decrease in the amplitude of accommodation or loss of accommodative ability with age. Etiology. Natural part of the aging process

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Presbyopia

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  1. Presbyopia Walter Huang, OD Yuanpei University Department of Optometry

  2. Definition • Latin definition • Presbyopia = “old man’s eye”

  3. Definition • Decrease in the amplitude of accommodation or loss of accommodative ability with age

  4. Etiology • Natural part of the aging process • Onset at approximately 40 years of age and over though may be earlier in low hyperopes

  5. Progression • Once presbyopia occurs, it increases over a period of 10 to 12 years, after which it stabilizes

  6. Symptoms • Blurry vision at near • Difficult or impossible to accommodate sufficiently for near work

  7. Increasing Near Point of Accommodation with Age

  8. Amplitude of Accommodation and Age (Donder’s Table)

  9. Near Work • Comfortable vision at near uses less than or equal to half of the available amplitude of accommodation • Near work becomes difficult when the amplitude of accommodation is less than 5.00D

  10. Example • Working distance at 40 cm requires 2.50D of accommodation • Patient A has 5.00D of accommodation • He can use up to 2.50D of accommodation comfortably • Therefore, he has just enough accommodative power for reading at 40 cm, and no reading glasses are required • Patient B has 3.00D of accommodation • He can use up to 1.50D of accommodation comfortably • Therefore, he needs an additional 1.00D of accommodative power for reading at 40 cm, and +1.00D reading glasses are required

  11. Management • Converging or plus lenses for near work only in spectacles or contact lenses • Changes in prescriptions are required every two to three years for presbyopia • Surgery

  12. Management • Spectacles • Single vision reading glasses • Multifocal lenses containing near Add • Bifocal lenses • Trifocal lenses • Progressive addition lenses

  13. Management • Contact lenses • Single vision contact lenses with glasses • Monovision contact lenses • Bifocal and multifocal contact lenses • Modified monovision contact lenses

  14. Management • Surgery • Laser in-situ keratomileusis (LASIK) • More for presbyopic hyperopia than presbyopia myopia at the moment • Multifocal intraocular lens (IOL) • Conductive keratoplasty (monovision) • Scleral expansion

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