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      Current Management of Presbyopia

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          Abstract

          Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life. The correction of presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability. There are however, a number of limitations and considerations that have prevented widespread acceptance of surgical correction for presbyopia. The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery. The purpose of this paper is to provide an update of current procedures available for presbyopia correction and their limitations.

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          Most cited references78

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          Global vision impairment due to uncorrected presbyopia.

          To evaluate the personal and community burdens of uncorrected presbyopia. We used multiple population-based surveys to estimate the global presbyopia prevalence, the spectacle coverage rate for presbyopia, and the community perception of vision impairment caused by uncorrected presbyopia. For planning purposes, the data were extrapolated for the future using population projections extracted from the International Data Base of the US Census Bureau. It is estimated that there were 1.04 billion people globally with presbyopia in 2005, 517 million of whom had no spectacles or inadequate spectacles. Of these, 410 million were prevented from performing near tasks in the way they required. Vision impairment from uncorrected presbyopia predominantly exists (94%) in the developing world. Uncorrected presbyopia causes widespread, avoidable vision impairment throughout the world. Alleviation of this problem requires a substantial increase in the number of personnel trained to deliver appropriate eye care together with the establishment of sustainable, affordable spectacle delivery systems in developing countries. In addition, given that people with presbyopia are at higher risk for permanently sight-threatening conditions such as glaucoma and diabetic eye disease, primary eye care should include refraction services as well as detection and appropriate referral for these and other such conditions.
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            Comparison of bifocal and trifocal diffractive and refractive intraocular lenses using an optical bench.

            To assess the differences in optical performance of 9 multifocal IOLs using the same optical bench and to propose a possible comparison for surgeons.
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              Associations of presbyopia with vision-targeted health-related quality of life.

              To evaluate the associations of presbyopia and its correction, particularly monovision optical correction, with vision-targeted health-related quality of life. The National Eye Institute Refractive Error Quality of Life (NEI-RQL) Instrument was prospectively self-administered by subjects from 6 medical centers in the following age and correction categories: subjects with emmetropia younger than 45 years (n = 75), subjects with emmetropia aged 45 years or older (n = 38), and subjects with ametropia aged 45 years or older without monovision (n = 486) or corrected with monovision (n = 38). Differences in the 13 NEI-RQL Instrument subscale scores among subjects in the 4 groups were examined. The age of 45 years or older was used as a surrogate for presbyopia. A comparison of older (age > or =45 years) vs younger (age <45 years) persons with emmetropia suggests that presbyopia was associated with reduced scores in 7 of 13 subscales (P<.05). In those aged 45 years or older, correction of presbyopia with monovision was associated with statistically significantly better scores on 3 subscales (expectations, dependence on correction, and appearance) compared with single-vision correction. One subscale (dependence on correction) showed worsening scores with increasing age without adjustment for need or type of correction. Older persons with monovision correction had significantly worse scores than younger subjects with emmetropia on all subscales except suboptimal correction and appearance. Presbyopia is associated with worse vision-targeted health-related quality of life compared with younger subjects with emmetropia. Monovision correction of presbyopia is related to some improvements in health-related quality of life, but it is still worse than that for younger subjects with emmetropia in several areas.
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                Author and article information

                Journal
                Middle East Afr J Ophthalmol
                Middle East Afr J Ophthalmol
                MEAJO
                Middle East African Journal of Ophthalmology
                Medknow Publications & Media Pvt Ltd (India )
                0974-9233
                0975-1599
                Jan-Mar 2014
                : 21
                : 1
                : 10-17
                Affiliations
                [1 ]Ophthalmology Clinic, Athens Metropolitan Hospital, Athens, Greece
                [2 ]Ophthalmology Department, Slovak Medical University, Bratislava, Slovakia
                [3 ]Medical Faculty, Comenius University, Bratislava, Slovakia
                Author notes
                Corresponding Author: Prof. Pandelis A. Papadopoulos, 42. Poseidon Avenue, Paleo Faliro, 17561, Athens, Greece. E-mail: eyedoc@ 123456hol.gr
                Article
                MEAJO-21-10
                10.4103/0974-9233.124080
                3959035
                24669140
                cea32265-f2f5-4698-938b-1195e08f43da
                Copyright: © Middle East African Journal of Ophthalmology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Refractive Surgery Update

                Ophthalmology & Optometry
                presbyopia,surgical correction,treatment
                Ophthalmology & Optometry
                presbyopia, surgical correction, treatment

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