Presbyopia is the age-related loss of accommodation due to reduced elasticity and flexibility of the lens. It begins in the 40s and progresses until complete loss of accommodation in the 50s-60s. Theories explain it is caused by reduced ciliary muscle contraction and increased lens diameter with age. Symptoms include difficulty with near vision, especially in low light. Treatments include reading glasses, contact lenses, and refractive surgeries like LASIK, conductive keratoplasty, and multifocal lenses. The goal is to improve near vision while maintaining good distance vision.
Pediatric Ophthalmic dispensing in different visual problemsRaju Kaiti
Pediatric dispensing, introduction, different from adult dispensing, frame selection, lens selection, special case fitting, Do's and Dont's, Measurements, Down's syndrome, albinism, aphakia, strabismus, syndromes
Synoptophore is an instrument for diagnosing imbalance of eye muscles and treating them by orthoptic methods. In this presentation the parts of the synoptophore and the different slides used in the instrument are discussed
Pediatric Ophthalmic dispensing in different visual problemsRaju Kaiti
Pediatric dispensing, introduction, different from adult dispensing, frame selection, lens selection, special case fitting, Do's and Dont's, Measurements, Down's syndrome, albinism, aphakia, strabismus, syndromes
Synoptophore is an instrument for diagnosing imbalance of eye muscles and treating them by orthoptic methods. In this presentation the parts of the synoptophore and the different slides used in the instrument are discussed
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/presbyopia-near-addition/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
Presentation containing information about all types of absorptive lenses its manufacturing, uses, advantages and disadvantages and some information about lens coatings.
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
SOFT CONTACT LENS FITTING
1. Alternative names of soft contact lens.
2. Need to know fitting requirement and performance requirements.
3. Centration and decentration of soft contact lens. -- There are cartesian system and binasal system.
4. what governs fitting of lens.
5. There are need to know about physical properties of soft contact lens.
6. Now, what is sag and sagital depth.
7. Finally, SAME SAG AND SAME DIAMETER but DIFFERENT DESIGN AND DIFFERENT BEHAVIOUR.
8. Parameters of soft contact lens -
total diameter
back optic zone radius
centre thickness
front optic zone radius
water content
9. There are two types of prescribing methods -
empirical prescribing
trial fit prescribing
10. Effect of a blink with soft contact lens - too flat and too steep.
11. Requirements of lens movement.
12. Lens lag position - primary gaze, up gaze and lateral gaze position.
13. Compulsory of lower lid push up test.
14. Ranges of fitting of soft contact lens - either too fit or too loose or ideal fitting.
15. All step of soft contact lens fitting is done.
Presbyopia/ Methods of Presbyopic Addition Determination (healthkura.com)Bikash Sapkota
DIRECT DOWNLOAD LINK ❤❤https://healthkura.com/presbyopia-near-addition/❤❤
Dear viewers Check Out my other piece of works at ❤❤❤ https://healthkura.com ❤❤❤
Presbyopia and techniques of measurement
A fantastic presentation in the topic "Presbyopia and techniques of measurement"
A detailed information about presbyopia, techniques of presbyopic add determination and different correction methods.
Informative slide presentation on presbyopia for ophthalmology residents, ophthalmologists, optometrists, ophthalmic assistants, ophthalmic technicians, ophthalmic nurses, medical students, medical professors, teaching guides.
Presentation Contents:
--Introduction to presbyopia
-Types of presbyopia
-Risk factors
-Symptoms and signs
-Refractive error and presbyopia
-Methods of determining near add.
-Management of presbyopia
In a nutshell..
- The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated
- Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the pt.'s quality of life
- Finally, every tentative addition should be adjusted according to the particular needs of the patient
For Further Reading:
-Clinical Procedures in Optometry by J.D. Bartlett, J.B. Eskridge, J.F. Amos
-Primary Care Optometry by Theodere Grosvenor
-Borish’s Clinical Refraction by W.J. Benjamin
-Clinical Procedures for Ocular examination by Carlson et al
-American Academy of Ophthalmology
-Optometric Clinical Practice Guideline by American Optometric Association
-Internet
Follow me to get in touch with optometric and ophthalmic updates.
Presentation containing information about all types of absorptive lenses its manufacturing, uses, advantages and disadvantages and some information about lens coatings.
Contact lens for congenital aphakia and other eye conditions for infants and toddlers. The slide presentation encompasses indications for CL fitting in paediatric, contact lens options, fitting techniques, challenges and contact lens as myopia control.
SOFT CONTACT LENS FITTING
1. Alternative names of soft contact lens.
2. Need to know fitting requirement and performance requirements.
3. Centration and decentration of soft contact lens. -- There are cartesian system and binasal system.
4. what governs fitting of lens.
5. There are need to know about physical properties of soft contact lens.
6. Now, what is sag and sagital depth.
7. Finally, SAME SAG AND SAME DIAMETER but DIFFERENT DESIGN AND DIFFERENT BEHAVIOUR.
8. Parameters of soft contact lens -
total diameter
back optic zone radius
centre thickness
front optic zone radius
water content
9. There are two types of prescribing methods -
empirical prescribing
trial fit prescribing
10. Effect of a blink with soft contact lens - too flat and too steep.
11. Requirements of lens movement.
12. Lens lag position - primary gaze, up gaze and lateral gaze position.
13. Compulsory of lower lid push up test.
14. Ranges of fitting of soft contact lens - either too fit or too loose or ideal fitting.
15. All step of soft contact lens fitting is done.
A lecture on the current techniques (mainly surgical) for the correction of Presbyopia. This includes information on static and dynamic surgical and non surgical approaches.
case presentation on presbyopia.age related changes in accommodation.types of presbyopia.theories of presbyopia.management options.age-related additions
presbyopia
So essentially, Presbyopia is the state in which, as a result of age and age processes, the least distance of distinct vision recedes beyond 25cm.
This is majorly due to loss of plasticity of the lens.
During accommodation, the lens fails to develop the desired convexity for adequate near vision around the age of 40 and above, a person complains of blurring of vision while reading or doing close work especially at night or in a condition of poor lighting.
Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...parkavenuelasek
Dr. Chynn graduated from Harvard's ophthalmology program, which is probably the most famous in the world.
As the only member of his graduating class to specialize in Refractive Surgery, and now an recognized authority, Dr. Chynn is frequently invited back to Harvard to give updates on the State of the Art in Refractive Surgery.
This slide show presentation was given to 100 eye surgeons who flew in from across the country to learn the latest advances in glaucoma, retina, cataract surgery--and laser vision correction (from Dr. Chynn).
The title of his talk reflects the movement in the US and worldwide from leading surgeons that is called "Back to the Surface." This means that surgeons are moving away from LASIK and IntraLase, to avoid flap complications and the # 1 problem causing lawsuits (iatrogenic keratoconus, or KC), and back to the surface.
For some doctors, this means going back to the original procedure, PRK, which has a lot of pain, delayed healing, and scarring.
For Dr. Chynn, this means performing an Advanced Surface Ablation, which is either a LASEK or epiLASEK. These are more advanced than PRK because they do not hurt, healing and recovery is quick, and there is no haze or scarring.
For example, Dr. Chynn performs over 1,000 LASEKs and epiLASEKs per year--he performed his last PRK in 1999.
Obviously, he moved away from PRK to LASIK, then to IntraLase, and now back to the safer LASEK and epiLASEK procedures.
View the following slide show to find out more, and call us with your questions--better yet, come in and meet with our MDs!
Troubleshooting bifocals and Market Availability in Nepal
Bifocals in Anisometropia
Prismatic Effect in Bifocal
Bifocal Prescription
Bifocals in High Astigmatism
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. PRESBYOPIA
• Physiological progressive age related loss of
accomodation due to reduced amplitude leading
to progressive fall in near vision.
• 1.3 billion world wide.
• Starts early in life.
• Loss of functional vision :in 40’s.
• Complete loss of accomodation in 50-60 years.
4. IN PRESBYOPIA
ciliary muscle contraction ceases
posterior zonular fibres pull the ciliary muscle
backward
increased tension on the zonular fibres
increase in lens diameter, decrease in lens thickness and
a flattening of the anterior and posterior lens surface
curvatures
decrease in optical power
6. IN PRESBYOPIA
growth of equatorial diameter of the lens
with age ,the perilenticular space is reduced
ciliary muscle contraction no longer tense the
zonules and expand coronally
• Based on this theory new sx for presbyopia
scleral expansion bands was introduced.
7. CATENARY THEORY BY COLEMAN
lens zonules and anterior vitreous comprises of a
diaphram b/w AC and vitreous
8. IN PRESBYOPIA
Increased lens volume with age results in a
reduced response of anterior radius of
curvature to the vitreous pressure gradient
created by ciliary body contraction.
13. • N/l young p/t-> lens can autofocus.
• Emmetrope:far point-α
Near point –increases with age.
• 10 yrs – 7 cms
• 20 yrs- 10 cms
• 30 yrs-14 cms
• 40 yrs- 20 cms
• 50 yrs-40 cms
• Amplitude of accomodation:
• 10 yrs-14 D
• 20 Yrs-10D
• 30 Yrs-7D
• 40 yrs-5D
14. • For comfortable vision
• >40 cms:1/2 of accomodation is to be kept in reserve.
• <40 cms:1/3 rd of accomodation is to be kept in
reserve.
• Usually near work becomes difficult when amplitude
of accomodation is <5 D.
AGE & PREDICTED NEAR ADD
• 45 yrs - +1D
• 50 Yrs-+1.50 D
• 55 yrs-+2.00 D
• 60 yrs-+2.25 D
15. CLASSIFICATION
• Incipient presbyopia:
• beginning stage
• Difficulty in near vision during dim illumination bt n/l on bright
illumination
• Premature presbyopia:
• occur at an earlier stage than expected for n/l population.
• Causes:ocular d/s,uncorrected hyperope,c/c simple glaucoma
General debility,presenile ciliary muscle weakness ,
Premature sclerosis of lens.
• Manifest presbyopia:
• presbyopia with some amplitude of accomodation.
• Absolute presbyopia:
• Amplitude of accomodation is completely absent
16. C/F
• Difficulty in near vision initially in evening and dim
light and latter even in good light
• Asthenopic symptoms like headache d/t fatigue of
ciliary muscles
• Intermittent diplopia due to associated disturbances
of convergence.
Aggravated by fatigue/ illness/ fever / other c/c d/ses.
SIGNS
• Reduced amplitude of accomodation
17. TESTS FOR NEAR VISION
• Addition based on amplitude of accommodation.
• Tentative addition based on age.
• Plus build-up method.
• Bichrome method.
• Cross-cylinder method.
• Relative accommodation method.
• Dynamic Retinoscopy method.
18. ADDITION BASED ON AMPLITUDE OF
ACCOMMODATION
• PRESBYOPIA
• NPA exceeds 8 inches (22cm) (Donders).
• amplitude of accommodation < 5D (Morgan).
Working distance (WD) = 40cm
RAF (Amp accommodation) = 2.00D
What should be the near addition ???
• Accommodation required for WD = 2.50 D
Accommodation in Reserve = 1.00D
• Amount of accommodation left = 1.00D
• Amount of Near addition = (2.50 –1.00)
= 1.50D
19. Working distance (WD) = 25 cm
RAF (Amp accommodation) = 1.50D
What should be near addition ???
Accommodation needed at WD = 4.00D
Amplitude held in reserve = 0.50D
Amplitude of accommodation left = 1.00D
Amount of near addition = (4.00-1.00)
= 3.00D
20. TENTATIVE ADDITION BASED ON AGE
Amplitude of accommodation to age (Hofstetter)
◦ Maximum = 25.0 – 0.4 (age)
◦ Probable = 18.5 – 0.3 (age)
◦ Minimum = 15.0 – 0.25 (age)
21.
22. PLUS BUILD UP METHOD
• The least amount of + lens which gives p/t a better
vision at near detected.
• BCVA kept b4 the p/t.
• At 40 cms: 6/6 line / letter : target.
• Ask if p/t sees clearly.
• If blurry add + lenses increased in steps of 0.25D to
the amount necessary to read the desired letters at
a customary working distance.if better:add 1 more
+,if same :back up 1 to get end point.
• Can be done binocularly or monocularly .
• Monocular build-up has amount of near addition
higher than binocular.
23. BICHROME METHOD
• Chromatic aberration
• Patient with distant BCVA
• Bichrome test at habitual distance in NV
• Ask patient which background letters are more
clear , Green-add plus, Red-remove plus until
he/she sees letters equally clear in both.
• In presbyopic patients red & green are focused
behind the retina with red farther away.
• Green appears clear.
• Plus lenses are added until both red & green appear
equally clear
24.
25. CROSSED CYLINDER TECHNIQUE
• A near point grid is diffusely illuminated & placed at
p/t’s customary working distance .Plus lenses are
added until lines seen clearly.
• Crossed cylinder (±0.50D) with their minus axes vertical
are placed before the patient’s eyes & asked to report
which sets of lines running across or up & down appear
clearer, sharper, blacker
• artificial astigmatism with an interval of sturm of 1D
created.
• If accommodates exactly for the target, both sets of
lines should be equally clear.
• under-accommodation, the horizontal lines will b
clear.Add positive lenses until lines are equally clear.◦
Can be done monocularly or binocularly
26.
27. RELATIVE ACCOMODATION METHOD
• Patient is provided with plus lenses determined by
other methods.target @ 40 cms 6/6 line.
• Determine :Plus lens to blur (NRA)
: Minus lens to blur(PRA)
• Near add = NRA+PRA/2
• THE NEAR ADD IS 1.00 (SAY)
• ADD MINUS LENSES UNTIL BLUR (1- 0.5)= +0.50 D
• ADD PLUS LENSES UNTIL BLUR (1+1) = +2.00 D
• FINAL ADD IS (+0.50+2.0)/2= 1.25D
29. MONOVISION
• presbyopia therapy
• Achieved through contact lenses or surgically at the
corneal or lenticular plane.
• Mild myopia –0.5 to –1.5D in non- dominant eye (avoid
anisometropia no more than 2D diff between the eyes)
• Need to be able to suppress blurred image • Only a
mild decrease in distance, good stereo, very good
intermediate vision.
• C/I:
• with high visual requirements for near or distance
• .
30.
31. GLASSES AND CONTACT LENSES
• Converging or plus lenses for near work .
• Change in prescriptions every two to three years.
36. CONDUCTIVE KERATOPLASTY
• Radio frequency energy is applied to mid peripheral
corneal stroma via probe that heats up the collagen and
causes it to shrink .
• Induces up to 1.5 to 2.0D of central steepening & corneal
flattening .
• Non-dominant eye corrected for near(monovision).
• Amt. of steepening α no. of spots & rings.
• Advantages:Extraocular, Relatively inexpensive,Can be
done with slit lamp ,And by non refractive surgeons .
• Disadvantage:Limited to hyperopes or emmetropes
,Induce irregular astigmatism , Regression of effect,
Corneal scaring
37.
38. Corneal Inlays
• Made of Biocompatible material placed in a pocket
created with a microkeratome or intralase flap within
cornea .
• Designed for use in emmetropic or hypermetropic eyes
• Aperture 1.6mm, outer rim 3.8mm .
• Pin hole effect increases depth of focus & alter the
way light rays enter the eye .
• Micro pores for nutrients.
• Advantages: a) Extraocular surgery b) Reversible
c) Exchangeable
• Eg: Kamra small aperture corneal inlay
39. • Flexivue Microlens
• 3-mm in diameter,15 microns thick.
• The lens is placed about 280 to 300 microns deep in
the cornea of non-dominant eye through a pocket
created using a femtosecond laser.
• The specific vision-correcting prescription is
incorporated in the outer area of the lens.
• Advantage :
10 min procedure,
pocket created self-seals & holds the lens in place.
40.
41.
42. EXCIMER LASER SURGERY
• Monovision:
• Dominant eye corrected for distance & Non
Dominant eye for near.
• Difficult to tolerate by most of the patients. Loss of
Contrast and depth perception by the patients.
Limited useful time.
• Multifocal Cornea:
• Excimer Laser reshapes the cornea and alters the
way light rays enter the eye. Hence called as
PRESBYLASIK.
• Both eyes see near & distance.
• Temporary solution , Repeatable and/or reversible
44. SCLERAL EXPANSION PROCEDURE
• Based on Schachar theory
• increasing zonular tension by weakening or altering
the sclera over the CB in order to allow for passive
expansion
• Small incisions in sclera close to cornea->4 silicon
bands inserted to tent sclera between band and
limbus ->Increases distance between ciliary muscle
and lens equator ->enhancing ciliary muscle
contraction
• Inconsistent results.
45. • Advantage :Extraocular
No adverse effects on quality of vision
• Disadvantage:Surgical time-40 mins per eye
Bloody surgery
Modest gains in near vision
Does Not Restore Accomodation
46.
47.
48. LASER ASSISTED PRESBYOPIA REVERSAL
(LAPR)
• Infrared Erbium:YAG delivered through a fibre contact tip
• 4 fornix based peritomies ->Ablations applied in scleral tissue
0.5mm posterior to the limbus to 80% thickness ->Peritomy
sites closed with bipolar forceps.
• complications :Microperforations
Conjunctival cysts
Iris atrophy
• Advantage :Extraocular procedure.
Surgically easy
No adverse effects on vision
• Disadvantage:Variable benefit to near vision
Regression
Expensive laser
50. PHAKIC INTRAOCULAR LENSES
• Lenses inserted over the iris/under the iris without
removing the natural Lens.
• Advantage :reversibility
51. MULTIFOCAL IOL
• Multiple zone IOLs placed after removal of lens.
• Diffractive multifocal IOL :
• Near & distant correction put in each concentric rings Using
diffraction optics with the principle of wave optics.
• Anterior surface - convex
• Posterior surface -stepped with step h8 in the range of wave
length of light.
• Diffraction from these rings produces waves in phase & in 2
diffractive orders,discrete optical foci & equal intensity.
• 82% light of which 41% 4 near n 41% 4 distance.
• Disadvantage:
• present more than one image to the retina at the same time
-> reduction in contrast ,Abberrations ( glare n halos) .
52. Refractive IOL /bull’s eye IOL
• 2 ZONE IOL’S
• Central (2mm) near vision segment surrounded by a distant
vision segment.
• ANNULUS TYPE IOL’S
• Central segment has a distant vision segment n near vision
ring outside it in turn surrounded by distant segment.
REZOOM TECHNIS RESTORE
53. Disadvantages of MIOL
>1 image presented to the retina at the same time .
• reduction in contrast
• Abberrations ( glare and halos)
• Pupil size may be an issue
54. ACCOMMODATING IOL’S
• mimic a juvenile lens - changes in shape by anterior movement
and dioptic power when the ciliary muscle contracts
• Advantage :reduction in contrast sensitivity–n/l.
:corrects near, intermediate and distance
:Abberrations -nil
• Mechanism
• optic shift principle :Has hinges at the lens haptic juncture.
:optic lie against vitreous face.
:ciliary muscle contraction-> vitreous
pressure & aqueous pressure.
: 1D power generated for 0.6 mm
movement .
• Dual optics : 2 lenses :↑ +ve a.lens & -ve p.lens .
seperated by spring like haptics .
:unaccomodated :2 lenses close 2 each other.
:accomodation:a. shifting of +ve lens.