Presbyopia

1
Presbyopia

• Walter Huang, OD
• Yuanpei University
• Department of Optometry

2
Definition

• Latin definition
• Presbyopia old mans eye

3
Definition

• Decrease in the amplitude of accommodation or
  loss of accommodative ability with age

4
Etiology

• Natural part of the aging process
• Onset at approximately 40 years of age and over
  though may be earlier in low hyperopes

5
Progression

• Once presbyopia occurs, it increases over a
  period of 10 to 12 years, after which it
  stabilizes

6
Symptoms

• Blurry vision at near
• Difficult or impossible to accommodate
  sufficiently for near work

7
Increasing Near Point of Accommodation with Age
Age (years) Distance (cm)
10 7
20 10
30 14
40 20
50 40
8
Amplitude of Accommodation and Age (Donders
Table)
Age (years) Amplitude (D) Age (years) Amplitude (D)
10 14.00 45 3.50
15 12.00 50 2.50
20 10.00 55 1.75
25 8.50 60 1.00
30 7.00 65 0.50
35 5.50 70 0.25
40 5.00 75 0.00
9
Near Work

• Comfortable vision at near uses less than or
  equal to half of the available amplitude of
  accommodation
• Near work becomes difficult when the amplitude of
  accommodation is less than 5.00D

10
Example

• Working distance at 40 cm requires 2.50D of
  accommodation
• Patient A has 5.00D of accommodation
• He can use up to 2.50D of accommodation
  comfortably
• Therefore, he has just enough accommodative power
  for reading at 40 cm, and no reading glasses are
  required
• Patient B has 3.00D of accommodation
• He can use up to 1.50D of accommodation
  comfortably
• Therefore, he needs an additional 1.00D of
  accommodative power for reading at 40 cm, and
  1.00D reading glasses are required

11
Management

• Converging or plus lenses for near work only in
  spectacles or contact lenses
• Changes in prescriptions are required every two
  to three years for presbyopia
• Surgery

12
Management

• Spectacles
• Single vision reading glasses
• Multifocal lenses containing near Add
• Bifocal lenses
• Trifocal lenses
• Progressive addition lenses

13
Management

• Contact lenses
• Single vision contact lenses with glasses
• Monovision contact lenses
• Bifocal and multifocal contact lenses
• Modified monovision contact lenses

14
Management

• Surgery
• Laser in-situ keratomileusis (LASIK)
• More for presbyopic hyperopia than presbyopia
  myopia at the moment
• Multifocal intraocular lens (IOL)
• Conductive keratoplasty (monovision)
• Scleral expansion