Presbyopia

Presbyopia Affects Everyone Eventually

Presbyopia is a universal eye disorder that causes close-up objects to become blurry and out-of-focus.

Do  you have to extend your hands when reading a magazine? Wish your hands were longer? Than you may have the age related eye disease called presbyopia or aging eyes. You may also have trouble seeing the dashboard of your car. Some folks cannot even see the computer clearly. Don’t feel bad.Everyone will have presbyopia when they get older; it is simply a matter of time before you start noticing its effects. Presbyopia is the reason why adults in their 40s and beyond need reading glasses.

Understanding Aging eyes

When you are young, your eye’s natural lens is soft and flexible, allowing it to change shape whenever you need to focus on different objects at different distances.

 

Unfortunately, as you age, the proteins in your lens become harder and less flexible, limiting the lens’s ability to change shape. When this happens, you will be unable to focus on near objects with the same clarity you once had.

At the same time the muscles which move the lens become weaker. They are unable to move and exert as much pressure as in youth

Why Does Presbyopia occur at different ages?

Some people have an earlier onset of aging eyes. Theses people are farsighted to begin with. That means they are not able to focus clearly at near in a relaxed state. When young they use their strong eye muscles to improve vision for near. These eyes gradually loose their muscle power. Hence they may have reading issues even in their late thirties.

On the other hand nearsighted people may enjoy reading for a longer time. As the term suggests they can see things at near but not far. Finally one day they cannot see at any distance and they require bifocals or even trifocal glasses. Some people combine contact lenses with glasses to overcome the effect of aging eyes.

Another group of people develop nuclear sclerotic cataracts. These cataract early on act as magnifying glasses. During that time reading may improve and called “Second Sight’.

Presbyopia Treatment options

Aging eyes can be treated by natural methods methods encompassing  exercise, nutrition  and altering lifestyle.

Learn more about Non Surgical Treatment Options for Presbyopia

Conventional treatment options include glasses. They can be of different types. Just readers or cheaters. Others may require bifocals and some need trifocals. No line progressives have helped some people. If you already wear glasses for myopia, you will need biofocals once presbyopia develops. The double lenses in bifocals allow you to correct your vision for presbyopia and nearsightedness at the same time. If you use contact lenses , you should only need basic reading glasses for clear vision. Multifocal contact lenses are an option which work for only a few people. With every blink the contact lenses move. We blink around 16 times per minute. That means the brain gets new images to sort every 6 seconds. resolving distance and near is too much in this short span.

There area a lot of disadvantages in wearing these heavy glasses. Ever try swimming in them? I think you dislike them in the rain too.

Surgical Treatment or Reversal of Presbyopia

There are two main ways to cure Presbyopia. Modulate the cornea or the natural lens.

Natural cornea is static that is it does not change shape. Surgery on cornea gives static change. This is not the way nature intended. Let us see how we can use the corneal surgery to help dispel presbyopia. There are three principles which achieve the desired result.We can either add power to the cornea by adding a synthetic ultrathin lens. This has been tried many times over the past few decades. Even human tissue inserts have been tried. The latest FDA approved raindrop implant has been abandoned by the manufacturer.

Another option used by Kamra inlay is utilizing the pinhole effect. A dark circular plastic with a hole in the center is implanted at a predetermined depth in the cornea.

Changing the shape of the cornea has been the most popular in the last two decades. This subject gets more interesting as one realizes there are many ways to change shape of the cornea with corresponding unique results. Traditionally the entire shape of the cornea can be made more curved with an excimer laser. This make s the cornea more powerful and allows one to see near. When a full correction is attempted there is loss of distance vision. This is termed as monovision. A partial correction called blend vision allows intermediate vision and some distance vision. Blend vision is more likely to allow the brain to fuse the two dissimilar images from the two eyes. A temporary method to achieve this was by LTK or Laser theromokeratoplasty and Ck or conductive keratoplasty. Both LTK and CK have largely been abandoned.

Converting the cornea from a monofocal to a multifocal is the goal of Presbylasik. Both eyes are operated with an excimer laser. There are alternate zones for distance and near.  The success rate is not as desired. Intracor femtosecond laser procedure attempts to help near vision by changing the shape of the central zone of the cornea. This increased spherical xzone of the cornea acts as a magnifying lens. The center sees near and the periphery of the cornea visualizes distance.

The common drawback with the corneal procedures is they attempt to treat presbyopia at a structure which is not the root cause of the problem. We know that the natural lens is the dynamic structure which is undergoing change and degeneration. When we operate on the cornea we do not halt the deterioration of the natural lens. Even if the cornea procedure is successful it may not last long. The lens may add aberrations both lower order and higher order. Corneal procedures cannot prevent cataract formation. Instead they make the calculation of the required lens power difficult. They may interfere with cataract procedure. Person may not be able to avail of advanced multifocal lenses if the corneal implant are still present. In essence in the majority of cases the corneal procedures last for a decade or two. Either natural regression or the natural changes inhuman lens leads to dampening of results.

Natural lens is the root cause of all problems related to presbyopia. The inability to change shape to increase power as objects move closer to the eye is the basic problem. It is due to the increased volume and stiffening of the natural lens and may be exacerbated by weakening muscles and zonules.

An innovative surgery called PIE (Presbyopic Implant in Eye) is designed to eliminate presbyopia by replacing the old, hardened lens of your eye with a new artificial lens.

There is no reason you should resign yourself to needing reading glasses or bifocals for the rest of your adult life. With PIE, you can have clear vision again for both near and far distances. Better still, you can avoid the development of cataracts later in life, since they cannot form on an artificial lens.If you are tired of living with presbyopia and want the clear vision of your youth back, please contact The Khanna Institute today to schedule a free screening. Please feel free to fill the form below if you have a question.

We serve patients throughout the Los Angeles area, with offices in Beverly Hills and Westlake Village, California.

By Rajesh Khanna , MD

Americas Top Ophthalmologist for PresbyopiaServing Los Angeles, California and Surrounding Communities