presbyopia symptoms and management

1. PRESBYOPIA
DR RAKHI P DCRUZ

2.  Condition of physiological insufficiency of accommodation
due to reduced amplitude leading to progressive fall in
near vision
 usually starts between 40-45 yrs of age.
 Near point varies with age 7cm=10yrs,25cm=40yrs
33cm=45yrs
 AMPLITUDE OF ACCOMODATION
 CAUSES
 1.age related changes in lens
 Decreased elasticity of lens capsule
 Progressive increase in size and hardness of lens
substance
 2.age related decline in ciliary muscle power

3. Premature presbyopia
 Uncorrected hypermetropia
 Premature sclerosis of crystalline lens
 Presenile weakness of ciliary muscles
 Chronic simple glaucoma
 SYMPTOMS
 Difficulty in near vision,asthenopia,intermittent diplopia
 Occur when accommodation needed to focus at near
exceed more than half of total amplitude of
eye.uncorrected hypermetrope and chronically
undercorrected myope will both develop presbyopic
sympptoms earlier than emmetrope

4. Treatment
 OPTICAL CORRECTION
 Supplementing accomodation with convex lenses of
appropriate power
38-39 +0.75
40 +1
41-44 +1 - +1.25
45 +1.5
46-49 +1.5 - +1.75
50 +2.0
51-54 +2.25
55 +2.5
56-59 +2.75

5.  Adjustment for working distance
 ADDS FOR INTERMEDIATE DISTANCE
+2.5 25cm
+1.5 33cm
+1.0 40cm
+0.5 50 cm

6.  MODES OF PRESCRIBING PREBYOPIC ADD
 Single vision reading glass
 Bifocal
 trifocal
 Multifocal
 SURGICAL OPTIONS
 CORNEAL PROCEDURES
 MONOVISION CONDUCTIVE KERATOPLASTY
 PRESBYOPIC BIFOCAL LASIK
 PRESBYOPIC MULTIFOCA LASIK
 CORNEAL INLAY