Presbyopia

What is Presbyopia?

Presbyopia is an age-related condition that causes difficulty in seeing nearby objects, typically occurring in individuals over the age of 40. The lens inside the eye has the ability to change shape. This unique ability allows the lens to become thicker when objects are brought closer, improving visual focus. However, after the age of 40, the eye gradually loses this ability.

Causes of Presbyopia

When an object moves closer to the eye, the brain processes the signal and sends it to the eye. In the "ciliary body" of the eye, muscles contract and relax, causing fibers to tighten or loosen. This movement adjusts the lens, making it thinner or thicker, and increasing its refractive power. With age, the eye loses this capability. Although not definitively proven, the most accepted theory for this age-related loss is the cellular aging theory, which likens the loss of this ability to aging processes such as graying hair. Thus, presbyopia is considered a physiological aging process rather than a pathological issue.

Presbyopia progresses predictably with age. After the age of 40, it increases by +1 diopter every 10 years:

• At age 50, presbyopia is approximately +2 diopters.
• At age 60, it reaches +3 diopters.

Interestingly, in cases of myopia (nearsightedness), presbyopia interacts with existing conditions. For example, a person with -2 diopters of myopia at age 40 would experience a net effect of -1 diopter for near vision. By age 50, such individuals may no longer require glasses for close-up tasks. This phenomenon explains why some myopic individuals claim to have excellent near vision as they age.

Symptoms of Presbyopia

• Difficulty focusing on objects within 50 cm.
• Holding objects at a distance to see them clearly.

Treatment for Presbyopia

There are multiple treatment methods for presbyopia, each with its own advantages and disadvantages. The most widely accepted and reliable treatments include Kamra Inlay, intraocular multifocal lens surgeries, and PresbyLASIK laser treatments, all of which are performed successfully in specialized medical centers.

Treatment Options

Kamra Inlay Treatment

This is a reliable method for treating age-related near vision problems, preferred by many ophthalmologists.

• A micro-implant, lighter than a grain of salt, is placed on the cornea using a femtosecond laser.
• The treatment is painless, completed within 10 minutes, and requires only local anesthetic eye drops.
• After the procedure, no stitches or bandages are needed, and patients can return to normal activities the next day.

Kamra Inlay corrects both near and distance vision without negatively affecting close-up vision.

Multifocal Intraocular Lens Treatment

• The natural lens of the eye is replaced with a lens that has multiple focal points.
• These lenses contain rings for both near and distant vision, allowing clear images to fall on the retina.
• Patients adapt quickly and can eliminate the need for glasses entirely.
• This treatment is particularly suitable for patients who require cataract surgery, addressing both cataract removal and vision correction in a single procedure.

PresbyLASIK Treatment

PresbyLASIK is a laser treatment that eliminates near vision problems. It is only suitable for individuals whose eye structure passes a series of examinations.

Monovision Excimer Laser Treatment

This technique intentionally leaves one eye slightly myopic (-0.75 or -1 diopters).

• The dominant eye is used for distance vision, while the other eye assists with near vision.
• This simple and widely used method allows patients to see well at both near and far distances with both eyes open.

Accommodative Lenses

These lenses mimic the natural movement of the eye's original lens and are surgically placed inside the eye.

Other Treatments

Surgical Treatments

Three areas can be targeted for surgical interventions:

1. Cornea: Includes Kamra Inlay, PresbyLASIK, Monovision Excimer Laser, and multifocal or pinhole lenses.
2. Lens: Involves multifocal or accommodative lenses.
3. Sclera: Involves scleral implants.

Non-Surgical Treatments

Eyeglasses:

• Bifocal or multifocal (progressive) glasses are effective options.

Contact Lenses:

• Multifocal contact lenses are suitable for patients with proper tear quality, but individuals over 40 may face challenges due to reduced tear production.