2. Introduction
It is an age related visual impairment results from the
gradual decrease in accommodation expected to age.
Types:-
Incipient presbyopia:- It represent the earliest stage,
patient's history suggest need for reading addition but the patient
perform well on testing
functional presbyopia:- require at least 1.00D in order to
read the N8 optotype at a distance of 40cm.
3. Absolute presbyopia:- As a result of continuous gradual
decline in accommodation, functional presbyopia progress to
absolute presbyopia.
premature presbyopia:- accommodative ability becomes
insufficient for patient's usual near vision tasks at an earlier age
than expected.
Nocturnal presbyopia:- near vision difficulties in dim light.
Increased pupil size is responsible for reduction in range of clear
vision in dim light.
4.
5. Signs and symptoms
Having difficulty reading small print
Delay in focusing at near
increased working distance need for reading
headache or eyestrain after reading or doing close work
need brighter light when reading or doing close work
6. Diagnosis of Presbyopia
1. Patient History
Expected Values of Accommodation (Diopters)
10 15.5
20 12.5
30 9.5
40 6.5
50 3.5
60 0.5
70 0.25
7. Diagnosis of Presbyopia
2. Ocular Examination
a) Visual Acuity
b) Refraction
c) Binocular Vision and Accommodation
i. Plus lens to clear near vision
ii. Amplitude of accommodation (AA)
8. Management of Presbyopia
A. Optical Correction with Spectacle Lenses
i. Single vision lenses
ii. Bifocal lenses
iii. Trifocal lenses
iv. Progressive addition lenses
v. Occupational lenses
9. Management of Presbyopia
B. Optical Correction with Contact Lenses
i. Monovision lenses
ii. Bifocal contact lenses
iii. Alternating vision bifocal contact lenses
iv. Simultaneous vision contact lenses
v. Combination of Contact and Spectacle Lenses
10. Management of Presbyopia
C. Refractive Surgery
i. Multifocal intraocular lens implant
ii. Accommodating intraocular lens implants
iii. Small-diameter corneal inlays
iv. Modified corneal surface techniques to create multifocal
corneas
v. Conductive keratoplasty (CK)
vi. Moldable intraocular lens implants (IOLs) to develop
pseudophakic accommodation.
11. Predicted Near Add
AGE PREDICTED NEAR ADD
40 0
45 +1.00
48 +1.25
50 +1.50
52 +1.75
55 +2.00
60 +2.25
63 +2.50
