Presbyopia: fighting against the effects of ageing

At present, IOL implantation is the treatment of choice for presbyopes. Results presented by advocates of the presbyopia-correcting IOLs have been promising so far, particularly with the newer models of multifocal and accommodative lenses. Naturally, this increasing interest has been accompanied by a flurry of activity in IOL development, leaving specialists with several choices.

In the past patients were faced with limited options. Today, however, it's a different story. Specialists can offer IOLs that restore near vision whilst enhancing night time vision and reducing spectacle dependence, with minimal unwanted side effects. In the very near future, surgeons will also be able to offer patients wavefront-designed IOLs.

Whichever lens a surgeon chooses for his or her patient and whether they decide to implant the same IOL into both eyes or to mix and match, one thing is for sure, visual outcomes will continue to improve. As the new generations of multifocal, accommodative and wavefront IOLs become available, surgeons will be able to offer even better reading ability and quality of vision, and someday they will even have the ability to truly customize the IOL to an individual patient's eye. That day will come soon enough.

Stepping away from IOLs, there are several other approaches that are making their way into the headlines; this includes procedures that involve an element of corneal modification. Whilst some believe that presbyopia can be remedied by excimer laser ablation (presbyLASIK) or by corneal inlays, others advocate the use of conductive keratoplasty (CK).

As always, it is never going to be easy to find the answer. An approach that might suit one patient may not necessarily be good enough for another. The one size fits all theory certainly does not apply here and, once again, surgeons are faced with the daunting task of rifling through the stacks of information to find the solution that works best for their practice and for their patients.

Hopefully this month's feature will help those of you who continue to be involved in gathering information and experience that will benefit your presbyopic patients.

It is always difficult to present a full picture of all that is going on in the world of presbyopia research and development but it is our intention to supply you with a good basis to get you thinking. We kick off the feature section with an overview of some of the studies that have recently gained attention. We then take a more detailed look into some areas of research with the help of experts who have put the tools into practice.

Accommodative IOLs set to dominate?

Accommodative IOLs will soon become the preferred solution for presbyopia, according to I. Howard Fine, MD of the Casey Eye Institute, Oregon Health & Science University, US, speaking at last September's ESCRS congress in London.

Although multifocal lenses are the current market favourites for correcting presbyopia, Dr Fine insists that accommodative lenses will come out on top. He believes that these offer several important advantages over their multifocal counterparts such as good vision at all distances, no unwanted retinal images, no loss of light energy, no loss of contrast sensitivity and no central nervous system adaptation.

Dr Fine cited a study with accommodative IOL crystalens (eyeonics) in which 73.5% of 130 patients implanted with the lens no longer required spectacles or wore them only occasionally following implantation. A further study in 124 patients found binocular uncorrected vision at 11 to 15 months to be 20/25 or better in 92%, 98% and 73% of patients for distance, intermediate and near vision, respectively.