Patients' attitudes and beliefs to presbyopia and its correction

BCLA CLEAR Presbyopia: Evaluation and diagnosis

It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.

BCLA CLEAR Presbyopia: Management with contact lenses and spectacles

This paper seeks to outline the history, market situation, clinical management and product performance related to the correction of presbyopia with both contact lenses and spectacles. The history of the development of various optical forms of presbyopic correction are reviewed, and an overview is presented of the current market status of contact lenses and spectacles. Clinical considerations in the fitting and aftercare of presbyopic contact lens and spectacle lens wearers are presented, with general recommendations for best practice. Current options for contact lens correction of presbyopia include soft simultaneous, rigid translating and rigid simultaneous designs, in addition to monovision. Spectacle options include single vision lenses, bifocal lenses and a range of progressive addition lenses. The comparative performance of both contact lens and spectacle lens options is presented. With a significant proportion of the global population now being presbyopic, this overview is particularly timely and is designed to act as a guide for researchers, industry and eyecare practitioners alike.

Factors influencing the need and willingness for presbyopic correction: a cross sectional study from south India

Presbyopia is an age-related physiological phenomenon in which eye gradually losses its ability to accommodate. It is one of the leading causes of visual impairment worldwide, especially in adults above the age of 40. If uncorrected, it can significantly impair a patient's quality of life. This study aims to evaluate the factors which affects patient's need and willingness to accept presbyopic correction. This cross-sectional analytical study was carried out in a semi urban tertiary care hospital from Jan 2021 to June 2022 among patients aged 40 and above who presented to Outpatient department (OPD). Demographic details, medical history, presenting ocular complaints pertaining to presbyopia, spectacle use and decision regarding using near vision correction were noted. Ocular examination included refraction and ocular biometry. Factors that may have influenced complaints of presbyopia or willingness to accept presbyopic correction were analysed. Three hundred and forty two patients with a mean age of 48.55 ± 6.68 years were included. Of these, 262 (76.61%) patients presented with chief complaints related to presbyopia. Those with higher educational qualification (p = 0.031), hypermetropia (p = 0.021), shallower AC depth (p = 0.028) and on medications for systemic ailments (p = 0.01), were more likely to present with chief complaints attributable to presbyopia. Among them, those with higher educational qualifications (p = 0.02) and skilled workers were more likely to accept near vision glasses (p = 0.02), while those with lower Hb (p = 0.01) and myopia (p = 0.01) were less likely to accept correction for presbyopia. Among the 80 patients without chief complaints related to presbyopia, 35 (43.75%) were not willing to accept near vision glasses. Those with higher BMI (p = 0.04) and hypermetropes (p = 0.05) were more willing to accept presbyopic correction. Presbyopia constitutes a significant reason for patients above the age of 40 visiting eye care facility. Multiple socio-economic, systemic and ocular factors influenced both the chief complaints related to presbyopia and willingness to accept presbyopic correction.

Factors Affecting Unmet Need for Presbyopia Correction Among School Teachers in Debre Tabor Town, Northwest Ethiopia

Background

Uncorrected presbyopia is the leading cause of near visual impairment among working-age adults in the world. In Ethiopia, there was limited evidence on the magnitude of uncorrected presbyopia and its associated factors among school teachers. Therefore, this study aimed to determine the magnitude of untreated presbyopia and its associated factors among school teachers in Debre Tabor town, Northwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted on 448 school teachers at Debre Tabor town using a simple random sampling technique. The data were collected using a face-to-face interview and a comprehensive ocular examination. A binary multivariable logistic regression model was conducted to identify associated factors of the uncorrected presbyopia.

Results

Generally, the prevalence of uncorrected presbyopia among school teachers was 63.62% (95% CI: 59.2-67.9). Age (35-45) (AOR: 4.56, 95% CI: 1.74, 11.91), female gender (AOR: 3.03, 95% CI: 1.75, 5.26), unaware of presbyopia (AOR: 2.35, 95% CI: 1.30, 4.25), unaware of refraction site (AOR: 4.21, 95% CI: 2.42, 7.33), no eye checkup history (AOR: 2.76, 95% CI: 1.52, 5.01), and no family history of spectacle use (AOR: 2.61, 95% 4.67) were significantly associated with uncorrected presbyopia.

Conclusion

In the current study, the magnitude of uncorrected presbyopia was high. Age below 45 years, female gender, lack of awareness of presbyopia and refraction site, lack of history of eye checkups, and family spectacle use were significantly associated with uncorrected presbyopia. The early correction of presbyopia, health education on presbyopia, and the provision of affordable spectacle corrections for school teachers were recommended.

New insights in presbyopia: impact of correction strategies

Presbyopia occurs when the physiologically normal age-related reduction in the eyes focusing range reaches a point, when optimally corrected for distance vision, that the clarity of vision at near is insufficient to satisfy an individual’s requirements. Hence, it is more about the impact it has on an individual’s visual ability to function in their environment to maintain their lifestyle than a measured loss of focusing ability. Presbyopia has a significant impact on an individual’s quality of life and emotional state. While a range of amelioration strategies exist, they are often difficult to access in the developing world and prescribing is generally not optimal even in developed countries. This review identified the need for a standardised definition of presbyopia to be adopted. An appropriate battery of tests should be applied in evaluating presbyopic management options and the results of clinical trials should be published (even if unsuccessful) to accelerate the provision of better outcomes for presbyopes.

Eye care seeking behavior among rural adults in South India: Tamil Nadu Rural Eye Examination (TREE) Study Report 1

Purpose

To present the eye care seeking behavior among rural adults in South India.

Methods

This cross-sectional study was conducted between 2019 and 2020 covering three blocks of the Thiruvannamalai district, Tamil Nadu, India. Door-to-door survey was performed to collect demographic information, status of literacy, occupation, and details of previous eye examination. Distance visual acuity was tested for individuals available in the house using a log MAR (logarithm of minimum angle of resonance) chart. Association between demographic details, details of previous eye examination, and status of vision was analyzed using logistic regression.

Results

A data of 12,913 individuals were included for the analysis, of which 6460 (50.03%) were females. Of the total individuals, 2007 (15.54%) had undergone an eye examination previously. There were 1639 (28.50%) people who had a vision less than 0.2 log MAR in at least one eye. The odds of reported 'previous eye examination' were more among females [odds ratio (OR) 1.48, 95% confidence interval (CI): 1.32-1.66, P < 0.001]; individuals aged above 60 years [OR: 11.46, 95% CI: 9.44-13.91, P < 0.001], between 40 and 60 years [OR: 10.43, 95% CI: 8.85-12.30, P < 0.001], and between 18 and 40 years [OR: 2.48, 95% CI: 2.16-2.84, P < 0.001]; illiterates (OR: 1.76, 95% CI: 1.45-2.15, P < 0.001); and farmers (OR: 1.32 95% CI: 1.12-1.55, P = 0.001).

Conclusion

The study presents the utilization of eye care among rural South Indian adults. Almost 84.46% of individuals had not undergone any eye examination. Robust measures to promote eye care management would help in effective utilization of eye care services among rural adults.

Development and Validation of a Lighting Facility for the Objective Assessment of the Visual Performance of Presbyopic Patients in a Series of Activities of Daily Living

Introduction The primary objective of this study is to develop and validate an experimental lighting facility that allows the evaluation of near and intermediate vision in different user-defined illuminance levels. Methods This is a prospective, randomized, controlled study. Normophakic patients populated three validation groups (VGs) according to their binocular uncorrected near visual acuity (UNVA): a) VG1, 0.0-0.1 logMAR; b) VG2, 0.4 logMAR; and c) VG3, 0.7 logMAR. All participants addressed 10 near and intermediate activities of daily life (ADLs) in the three following lighting settings: 1) 25 foot candles (fc)/3000 kelvins (K), 2) 50 fc/4000 K, and 3) 75 fc/6000 K. Results Thirty patients in each group performed all ADLs in the three lighting settings. VG1 demonstrated the best ADL scores in all ADLs and lighting settings, followed by the VG2. VG3 presented the worst scores. ADLs using printed material showed significant differences among the three lighting settings for all study groups, while ADLs using screens or needing manual dexterity demonstrated no significant differences except for the Screwdriver Test (ST) in VG1. All ADL scores demonstrated a high correlation with UNVA in all lighting settings (p < 0.001). Conclusion This is the first study that validates a lighting facility for comparative studies in patients with different near vision capacities performing a series of ADLs.

Correcting Presbyopia With Autofocusing Liquid-Lens Eyeglasses

OBJECTIVE

Presbyopia, an age-related ocular disorder, is characterized by the loss in the accommodative abilities of the human eye. Conventional methods of correcting presbyopia divide the field of view, thereby resulting in significant vision impairment. We demonstrate the design, assembly and evaluation of autofocusing eyeglasses for restoration of accommodation without dividing the field of view.

METHODS

The adaptive optics eyeglasses comprise of two variable-focus liquid lenses, a time-of-flight range sensor and low-power, dual microprocessor control electronics, housed within an ergonomic frame. Subject-specific accommodation deficiency models were utilized to demonstrate high-fidelity accommodative correction. The abilities of this system to reduce accommodation deficiency, its power consumption, response time, optical performance and MTF were evaluated.

RESULTS

Average corrected accommodation deficiencies for 5 subjects ranged from -0.021 D to 0.016 D. Each accommodation correction calculation was performed in ∼67 ms which consumed 4.86 mJ of energy. The optical resolution of the system was 10.5 cycles/degree, and featured a restorative accommodative range of 4.3 D. This system was capable of running for up to 19 hours between charge cycles and weighed ∼132 g.

CONCLUSION

The design, assembly and performance of an autofocusing eyeglasses system to restore accommodation in presbyopes has been demonstrated.

SIGNIFICANCE

The new autofocusing eyeglasses system presented in this article has the potential to restore pre-presbyopic levels of accommodation in subjects diagnosed with presbyopia.

Presbyopia - A Review of Current Treatment Options and Emerging Therapies

Presbyopia is a common age-related vision disorder characterized by a progressive inability to focus on near objects. If uncorrected or under-corrected, presbyopia can significantly impact patients' quality of life. Presbyopia represents an area of considerable unmet need due to its rising prevalence worldwide as the population ages, the high proportion of under-treated individuals in some parts of the world, and the limitations of currently available corrective methods. Progressive or bifocal spectacles are associated with peripheral blur, a restricted visual field and impaired depth perception, which have been linked to an increased risk of falls in the elderly. Contact lens options can be difficult to maintain due to the development of age-related dry eye symptoms and reduced manual dexterity. Other corrective methods involve surgical interventions that modify the optics of the cornea, replace the crystalline lens, or attempt to restore active accommodation. While patients undergoing surgery report satisfactory outcomes post-operatively, many of them eventually require reading glasses. Non-invasive therapies with novel mechanisms of action are currently being investigated; these include miotic agents and UNR844, a lipoic acid choline ester. In this narrative review, available evidence on presbyopia prevalence, quality of life impact and risk factors are described, with a focus on observational studies in non-clinical settings. The diagnosis pathway and patient journey in presbyopia are outlined, and various treatment options are analyzed. The data reviewed herein reveals significant gaps in the provision of vision correction for this common condition, with a paucity of effective, non-invasive treatment options broadly accessible to presbyopic individuals.

Inlays and the cornea

Presbyopia is a growing problem in view of an aging global population and increasingly patients desire spectacle-free solutions to address this condition. Surgically implanted corneal inlays have been the topic of renewed research efforts in the past several years as a treatment option for presbyopia, with several approaches being used to modify the refractive properties of the cornea and enhance near vision. In this review we discuss historical approaches to corneal inlay surgery, critically appraise the current generation of presbyopia-correcting corneal inlays and their associated complications and consider the future prospects for emerging corneal inlay technologies that aim address the shortcomings of currently available inlays.

Near Vision Spectacle Coverage and Associated Factors Among Adults Living in Finote Selam Town, Northwest Ethiopia: Community-Based Cross-Sectional Study

Background

Near visual impairment leads to difficulty with near tasks at a working distance (40 centimeters) when near visual acuity is 6/12 (N8) or worse. High cost is the main barrier reported for low near vision spectacle coverage.

Objective

This study aimed to determine near vision spectacle coverage and associated factors among adults living in Finote Selam town, Northwest Ethiopia.

Methods

A community-based, cross-sectional study was applied from June 3 to 25, 2019. A total of 565 study participants aged ≥35 years were recruited using a systematic random sampling technique. A pre-tested questionnaire with adequate physical examination was used for data collection. The data were entered into EPI INFO software and exported to a statistical package for science for analysis. Mean (standard), frequencies, tables, and figures were used to present descriptive statistics. A bi-variable and multivariable logistic regression was used to determine the association between independent variables and outcome variable with a P-value of less than 0.20 and a P-value of less than 0.05, respectively. Odds ratios and a 95% confidence interval were used to show strength of association.

Results

A total of 549 adults participated, with a response rate of 97.20% and a mean age of 46.4±8.7 years. The near vision spectacle coverage was 156 (28.42%; 95% CI=24.65-32.31). Higher education level (AOR=2.8; 95% CI=1.21-5.21), history of eye examination (AOR=2.40; 95% CI=1.51-3.81), awareness about near vision problems (AOR=2.12; 95% CI=1.41-3.24), and need of a high plus lens (AOR=4.21; 95% CI=2.41-7.39) were associated with near vision spectacle coverage.

Conclusion

Near vision spectacle coverage was low among adults living in Finote Selam town. Higher educational level, history of eye examination, awareness about near vision problems, and need of a high plus lens were associated with near vision spectacle coverage.