In 1760, Benjamin Franklin provided the first tool in presbyopic correction with the invention of bifocals. A great deal has changed in the world of vision correction since that time, and, glasses are unfortunately a nuisance—easily lost, always in the way, and a constant reminder of fading youth. Who would not like to be free of both spectacles and the less-than-desirable effects of a lack of accommodation? I believe that no patient population will have a larger worldwide impact on refractive surgery than the presbyopic age group.
What are the surgical options for presbyopia? Ophthalmologists are currently contemplating numerous approaches. They are evaluating the cornea and sclera, as well as the anterior and posterior chambers. Multifocal laser ablations—whether central steepening or midperipheral steepening—are the least invasive target-tissue approaches. Scleral weakening, incising, lasering, and implantation continue to be areas of intense study. At times, I feel lost when trying to comprehend the mechanism of action at the target tissue with scleral approaches. Is it the weakening/expansion or the indentation over the ciliary body that is causing the accommodative increase? As we lean toward intraocular correction, the issue becomes the effectiveness of multifocal versus accommodative lenses. Internationally, we see both pseudophakic and phakic multifocal lenses available. To date, the pseudophakic multifocal lenses have been anterior chamber angle-supported.
At this point, there are many unanswered questions surrounding the treatment of presbyopia. Will there be preferred techniques for early versus late presbyopia? For example, will scleral or corneal laser techniques be adequate for the 40- to 50-year-old age group, and will intraocular treatments prove best for those who are older than 50 years of age?
I hope that this issue of Cataract & Refractive Surgery Today piques your interest in presbyopic management and shows you that industrial and clinical investigation is progressing toward offering the best products available to the presbyopic population. Here's to reaching the presbyopic Fountain of Youth!