Pharmacological treatments for the correction of presbyopia.

Presbyopia affects between 1.7 and 2 billion people worldwide. Presbyopia significantly impacts productivity and quality of life in both developed and developing countries. During accommodation, the human eye changes its dioptric power by altering the shape of the lens, but the exact nature of this change has not been fully explained. Recently, topical treatments have been marketed for the treatment of presbyopia and others are under investigation. In order to prepare a review of these novel therapies, we searched the major biomedical search engines. We found 15 randomized clinical trials and 12 reviews that met our review criteria. There are two different strategies for this purpose, the pinhole effect that increases depth of focus and "crystalline lens relaxation" for which parasympathetic mimetics and lens oxidation intermediates have been used. The results are generally favorable in terms of improvement of near visual acuity, although the follow-up period of the studies is short. These are novel strategies in the early stages of research that could be useful in the treatment of presbyopia.

Tendencias actuales en el manejo clínico quirúrgico de la presbicia / Current Trends in the Clinical and Surgical Management of Presbyopia

La presbicia es la pérdida gradual y progresiva de la amplitud de acomodación del cristalino que comienza entre los 38 y 40 años de edad y culmina a los 55 años al perderse por completo. Es provocada por el aumento de rigidez del cristalino y, en particular, un mayor cambio en la rigidez del núcleo de su corteza. La presbicia no corregida o hipocorregida tiene un impacto negativo en la calidad de vida en relación con la visión, las personas afectadas experimentan un cambio positivo significativo de productividad en sus actividades diarias al utilizar una corrección óptica adecuada. Las diferentes alternativas de tratamiento deben aplicarse de forma personalizadas para optimizar el rango de enfoque para las tareas diarias, minimizar los efectos visuales adversos y cumplir con las expectativas del paciente según necesidades y alcance económico. Los tratamientos más efectivos y con menos efectos indeseables hasta el momento son los dispositivos ópticos como las gafas y las lentes de contacto. Los métodos quirúrgicos pueden dejar síntomas visuales. El objetivo de este estudio fue realizar una búsqueda bibliográfica sobre las actuales tendencias en el manejo clínico-quirúrgico de la presbicia(AU)

Presbyopia is the gradual and progressive loss of the accommodative range of the crystalline lens that begins between 38 and 40 years of age and culminates at 55 years of age when it is completely lost. It is caused by increased stiffness of the lens and, in particular, a greater change in the stiffness of the nucleus of its cortex. Uncorrected or undercorrected presbyopia has a negative impact on quality of life in relation to vision, affected individuals experience a significant positive change in productivity in their daily activities when using an appropriate optical correction. The different treatment alternatives should be applied in a personalized way to optimize the range of focus for daily tasks, minimize adverse visual effects and meet the patient's expectations according to needs and economic scope. The most effective treatments with the least undesirable effects so far are optical devices such as glasses and contact lenses. Surgical methods may leave visual symptoms. The aim of this study was to perform a literature search on current trends in the clinical-surgical management of presbyopia(AU)

Phakic intraocular lenses: Recent advances and innovations. / Lentes intraoculares fáquicas: recientes avances e innovaciones.

Phakic intraocular lenses (pIOL) are recommended when counselling refractive surgery candidates presenting with high ametropia or ocular surface and/or corneal conditions that contraindicate corneal refractive surgery. This review aims to present the state-of-the-art regarding pIOL models currently available in Europe, addressing their newer indications and recent design innovations. These include, in the case of posterior chamber pIOLs, the addition of a central hole to improve aqueous humour circulation, the availability of larger optical zones, and multifocal optics for the compensation of presbyopia. The review also highlights their good safety and efficacy results, as well as the role of patient education to ensure adequate outcomes in the medium-long term. The indications of pIOLs in special situations, as well as bi-lensectomy, a procedure that most pIOL patients may eventually require as they age and develop cataracts, are also addressed.

Presbyopic correction use and its impact on quality of vision symptoms.

AIM: To assess real-world adoption of presbyopic correction and its impact on quality of vision. METHOD: The use of visual corrections by 529 sequential patients (aged 36 years to 85 years, 50.4% female) attending 4 optometric practices in diverse areas across London were surveyed by interview and completed the quality of vision (QoV) questionnaire to evaluate visual symptoms. RESULTS: Over half of the population (54.7%) managed without glasses at least some of the time, while between 30 and 40% wore distance, reading and progressive spectacles with those using Progressive Addition Lenses wearing them over 80% of the time, while those wearing reading spectacles only approximately 25% of the time. Age, sex and driving frequency had no effect of QoV (p>0.05), whereas the distance of the task significantly impacted QoV (p<0.01). In all QoV metrics, regardless of the far, intermediate or near blur assessment, QoV was rated higher by patients whose main tasks were far focused (n=231, 43.9%), than those who principally conduct intermediate tasks (n=165, 31.4%) and worse still for those whose main tasks were near (n=130, 24.7%), regardless of the form of correction. CONCLUSION: Majority of tasks are in the distance and these had a higher QoV than intermediate tasks with near focused tasks being even worse. It is important to discuss with patients the principal distance of the tasks they generally perform and the forms of presbyopic correction used from the outset.

Effect of age in the ciliary muscle during accommodation: Sectorial analysis.

PURPOSE: To compare changes in the ciliary muscle area at different sectors between pre-presbyopic and presbyopic eyes during accommodation by means of an anterior segment optical coherence tomographer (OCT). METHODS: The anterior ciliary muscle area was measured in 20 healthy and phakic pre-presbyopic eyes, whose mean age was 23.3±4.4 years, and in 20 healthy and phakic presbyopic eyes, whose mean age was 46.5±5.2 years. The relative change in the cross-sectional area of the ciliary muscle was measured at the nasal, inferior, and temporal sectors between 0 and -3 D of vergence, in -1 D step. A linear model was used to assess the correlation of each eye parameter with the accommodative demand. RESULTS: Each population group showed a significant increase in the anterior ciliary muscle area for each sector. The maximum increase in the ciliary muscle area within the pre-presbyopic group was about 30%, and for the presbyopic one was about 25%. At the same time, it was obtained that the larger the vergence, the larger the variability. Furthermore, the linear model showed a positive tendency between the change in the ciliary muscle area of each sector and the vergence for both population groups, which coefficient of determination was in all cases greater than 0.93. CONCLUSION: The anterior ciliary muscle area tends to increase with accommodation. The presbyopic nasal, inferior, and temporal ciliary muscle seem to have the same contractile capability as the young presbyopic ciliary muscle. These results might help to increase the evidences in the knowledge regarding the modern understanding of accommodation biometry and biomechanics.

Measuring the heterophoria: Agreement between two methods in non-presbyopic and presbyopic patients.

PURPOSE: To establish whether the cover test and von Graefe methods are interchangeable in a non-presbyopic and presbyopic population. METHODS: We performed a prospective study on a sample of 127 non-presbyopic subjects between 20 and 45 years old and 56 presbyopic between 40 and 78 years old. Distance and near vision phoria were measured using the von Graefe method (VG) and cover test (CT). We analyzed the significant differences between methods, their correlation and the agreement between them using the Bland and Altman method. RESULTS: For distance vision, heterophoria values for non-presbyopic subjects were -0.61±1.86Δ with CT and -0.88±2.37Δ with VG, and for presbyopic subjects were -0.56±1.64Δ with CT and -0.85±1.94Δ with VG. For near vision, CT yielded -3.02±3.97Δ, while VG achieved -3.49±4.70Δ in non-presbyopic subjects. For presbyopic subjects these values were -6.05±4.38Δ with CT and -6.29±4.19Δ with VG, respectively. Statistically significant differences between the two methods were observed for all groups analyzed (p<0.05), except for near vision in presbyopic subjects (p>0.05). Coefficient of agreement for non-presbyopic was ±2.97Δ for distance vision and ±6.74Δ at near. For presbyopic patients, this coefficient was ±1.59Δ for distance and ±1.86Δ for near vision. CONCLUSION: Cover test and von Graefe methods have a high level of agreement for both distance and near vision when considering presbyopic subjects. For non-presbyopic patients, the level of agreement is very low. Both methods for measuring heterophoria can only be considered interchangeable for presbyopic patients. For clinical purposes, this implies that any method can be used for measuring heterophoria in presbyopic patients.

Extended depth of focus contact lenses vs. two commercial multifocals: Part 2. Visual performance after 1 week of lens wear.

PURPOSE: To compare the visual performance of prototype contact lenses designed via deliberate manipulation of higher-order spherical aberrations to extend-depth-of-focus with two commercial multifocals, after 1 week of lens wear. METHODS: In a prospective, participant-masked, cross-over, randomized, 1-week dispensing clinical-trial, 43 presbyopes [age: 42-63 years] each wore AIROPTIX Aqua multifocal (AOMF), ACUVUE OASYS for presbyopia (AOP) and extended-depth-of-focus prototypes (EDOF) appropriate to their add requirements. Measurements comprised high-contrast-visual-acuity (HCVA) at 6m, 70cm, 50cm and 40cm; low-contrast-visual-acuity (LCVA) and contrast-sensitivity (CS) at 6m and stereopsis at 40cm. A self-administered questionnaire on a numeric-rating-scale (1-10) assessed subjective visual performance comprising clarity-of-vision and lack-of-ghosting at various distances during day/night-viewing conditions and overall-vision-satisfaction. RESULTS: EDOF was significantly better than AOMF and AOP for HCVA averaged across distances (p≤0.038); significantly worse than AOMF for LCVA (p=0.021) and significantly worse than AOMF for CS in medium and high add-groups (p=0.006). None of these differences were clinically significant (≤2 letters). EDOF was significantly better than AOMF and AOP for mean stereoacuity (36 and 13 seconds-of-arc, respectively: p≤0.05). For clarity-of-vision, EDOF was significantly better than AOP at all distances and AOMF at intermediate and near (p≤0.028). For lack-of-ghosting averaged across distances, EDOF was significantly better than AOP (p<0.001) but not AOMF (p=0.186). EDOF was significantly better than AOMF and AOP for overall-vision-satisfaction (p≤0.024). CONCLUSIONS: EDOF provides better intermediate and near vision performance than either AOMF or AOP with no difference for distance vision after 1 week of lens wear.

Refraction during incipient presbyopia: The Aston Longitudinal Assessment of Presbyopia (ALAP) study.

PURPOSE: To investigate non-cycloplegic changes in refractive error prior to the onset of presbyopia. METHODS: The Aston Longitudinal Assessment of Presbyopia (ALAP) study is a prospective 2.5 year longitudinal study, measuring objective refractive error using a binocular open-field WAM-5500 autorefractor at 6-month intervals in participants aged between 33 and 45 years. RESULTS: From the 58 participants recruited, 51 participants (88%) completed the final visit. At baseline, 21 participants were myopic (MSE -3.25±2.28 DS; baseline age 38.6±3.1 years) and 30 were emmetropic (MSE -0.17±0.32 DS; baseline age 39.0±2.9 years). After 2.5 years, 10% of the myopic group experienced a hypermetropic shift (≥0.50 D), 5% a myopic shift (≥0.50 D) and 85% had no significant change in refraction (<0.50 D). From the emmetropic group, 10% experienced a hypermetropic shift (≥0.50 D), 3% a myopic shift (≥0.50 D) and 87% had no significant change in refraction (<0.50 D). In terms of astigmatism vectors, other than J45 (p<0.001), all measures remained invariant over the study period. CONCLUSION: The incidence of a myopic shift in refraction during incipient presbyopia does not appear to be as large as previously indicated by retrospective research. The changes in axis indicate ocular astigmatism tends towards the against-the-rule direction with age. The structural origin(s) of the reported myopic shift in refraction during incipient presbyopia warrants further investigation.

Extended depth of focus contact lenses vs. two commercial multifocals: Part 1. Optical performance evaluation via computed through-focus retinal image quality metrics.

PURPOSE: To compare the computed optical performance of prototype lenses designed using deliberate manipulation of higher-order spherical aberrations to extend depth-of-focus (EDOF) with two commercial multifocals. METHODS: Emmetropic, presbyopic, schematic eyes were coupled with prototype EDOF and commercial multifocal lenses (Acuvue Oasys for presbyopia, AOP, Johnson & Johnson & Air Optix Aqua multifocal, AOMF, Alcon). For each test configuration, the through-focus retinal image quality (TFRIQ) values were computed over 21 vergences, ranging from -0.50 to 2.00D, in 0.125D steps. Analysis was performed considering eyes with three different inherent aberration profiles: five different pupils and five different lens decentration levels. RESULTS: Except the LOW design, the AOP lenses offered 'bifocal' like TFRIQ performance. Lens performance was relatively independent to pupil and aberrations but not centration. Contrastingly, AOMF demonstrated distance centric performance, most dominant in LOW followed by MED and HIGH designs. AOMF lenses were the most sensitive to pupil, aberrations and centration. The prototypes demonstrated a 'lift-off' in the TFRIQ performance, particularly at intermediate and near, without trading performance at distance. When compared with AOP and AOMF, EDOF lenses demonstrated reduced sensitivity to pupil, aberrations and centration. CONCLUSION: With the through focus retinal image quality as the gauge of optical performance, we demonstrated that the prototype EDOF designs were less susceptible to variations in pupil, inherent ocular aberrations and decentration, compared to the commercial designs. To ascertain whether these incremental improvements translate to a clinically palpable outcome requires investigation through human trials.

Non-lens-based surgical techniques for presbyopia correction. / Técnicas quirúrgicas no cristalinianas para la corrección de la presbicia.

INTRODUCTION: Presbyopia is the most prevalent refractive error. With a progressive aging population, its surgical correction is an important challenge for the ophthalmology community, as well as the millions of patients who suffer from it, and who are increasingly demanding alternatives to its correction with glasses or contact lenses. MATERIAL AND METHODS: A review is presented with a synthesised discussion on the pathophysiological theories of presbyopia and an updated and analytical description of the non-lens involvement surgical techniques used to treat presbyopia. RESULTS: Corneal procedures include various types of corneal implants and photo-ablative techniques that generate a multifocal cornea, or monovision. Scleral procedures exert a traction on supralenticular sclera that supposedly would improve the amplitude of accommodation. CONCLUSIONS: None of the techniques are able to completely eliminate the need for near -vision glasses, but many of them manage to improve the refractive status of the patients. More studies with rigorous and standardised methods and longer follow-up are needed to evaluate the changes in the near vision of the patients, in order to corroborate the real and practical usefulness of many of these techniques.

Short-term comparison between extended depth-of-focus prototype contact lenses and a commercially-available center-near multifocal.

PURPOSE: To compare the visual performance of prototype contact lenses which extend depth-of-focus (EDOF) by deliberate manipulation of multiple higher-order spherical aberration terms and a commercially-available center-near lens (AIR OPTIX Aqua Multifocal, AOMF). METHODS: This was a prospective, cross-over, randomized, single-masked (participant), short-term clinical trial where 52 participants (age 45-70 years) were stratified as low, medium or high presbyopes and wore EDOF and AOMF on different days. Objective measures comprised high and low contrast visual acuity (HCVA/LCVA, logMAR), and contrast sensitivity (log units) at 6m; HCVA at 70cm, 50cm and 40cm and stereopsis (seconds of arc) at 40cm. HCVA at 70cm, 50cm and 40cm were measured as "comfortable acuity" rather than conventional resolution acuity. Subjective measures comprised clarity-of-vision and ghosting at distance, intermediate and near, overall vision satisfaction and ocular comfort (1-10 numeric rating scale) and lens purchase (yes/no response). Statistical analysis included repeated measures ANOVA, paired t-tests and McNemar's test. RESULTS: Significant differences between lens types were independent of strata (p≥0.119). EDOF was significantly better than AOMF for HCVA at 40cm (0.42±0.18 vs. 0.48±0.22, p=0.024), stereopsis (98±88 vs. 141±114, p<0.001), clarity-of-vision at intermediate (8.5±1.6 vs. 7.7±1.9, p=0.006) and near (7.3±2.5 vs. 6.2±2.5, p=0.005), lack-of-ghosting (p=0.012), overall vision satisfaction (7.5±1.7 vs. 6.4±2.2, p<0.001) and ocular comfort (9.0±1.0 vs. 8.3±1.7, p=0.002). Significantly more participants chose to only-purchase EDOF (33% vs. 6%, p=0.003).). There were no significant differences between lens types for any objective measure at 6m or clarity-of-vision at distance (p≥0.356). CONCLUSIONS: EDOF provides better intermediate and near vision performance in presbyopes than AOMF with no difference for distance vision during short-term wear.

Effect of defocus on response time in different age groups: A pilot study.

PURPOSE: To assess the response time associated with visual performance (VP) tasks in the presence of defocus in different presbyopic populations. METHODS: 58 eyes between the ages of 35 and 50 years were studied. Subjects were categorized as pre-presbyopic (35-39 years), early-presbyopic (40-45 years), and mid-presbyopic (46-50 years). VP measurements obtained monocularly included distance and near high contrast (HC) and low contrast (LC) optotype recognition, and contrast threshold at 12cpd for different defocus magnitudes between 0D and 3D in 1D steps. Response time defined as the time taken to recognize and verbalize an optotype, was compared among different presbyopic age groups. RESULTS: From 58 eyes, mean (SD) response time for high contrast distance visual acuity for 0D through 3D ranged between 1.48 (0.23) and 1.87 (0.31)s, whereas low contrast distance visual acuity ranged between 1.5 (0.22) and 2.09 (0.49)s. Mean response time for high contrast near visual acuity for 0D through 3D ranged between 1.56 (0.19) and 2.23 (0.45)s. However, for low contrast near visual acuity it ranged between 1.75 (0.32) and 2.71 (0.94)s. Mean (SD) response time for 12cpd ranged between 2.11 (0.50) and 5.72 (1.09)s. ANOVA revealed a significant difference in response time for distance, near visual acuity and contrast sensitivity as a function of defocus for different age groups. CONCLUSIONS: Response time is increased in the presence of increasing defocus for both distance and near visual acuity and could impact on performance for critical tasks. Full correction of visual acuity at distance and near in presbyopes is warranted always.

Pupil diameter, working distance and illumination during habitual tasks. Implications for simultaneous vision contact lenses for presbyopia.

PURPOSE: To determine working distance, pupil diameter and illumination in real life conditions in a sample of presbyopic participants performing habitual tasks. METHODS: A total of 59 presbyopic subjects (aged between 45 and 63 years) with different occupational backgrounds participated in the study. Participants were first interviewed regarding their habitual tasks with the aid of an ad hoc questionnaire, following which in-office photopic and mesopic pupil diameter was determined. Pupil diameter was also evaluated while participants conducted each of the self-reported habitual tasks by taking a photograph, which was later submitted to image analysis. In addition, working distance was determined with a measuring tape and the illumination that reached the pupil during each of the different tasks was measured, in lux, with a light meter. RESULTS: The four most common habitual tasks were computer use, reading, sewing and sports. A high intersubject variability was found in pupil diameter, working distance and illumination conditions while conducting the same task. Statistically significant differences were found between the in-office measured photopic and mesopic pupil diameters and those obtained while participants were conducting their habitual tasks in real life conditions (all p<0.001). CONCLUSIONS: Potential multifocal contact lens users may present with different ages, different jobs or hobbies and different preferences regarding lighting conditions and working distances. This results in different pupil size, even within the same task. This information may be critical when selecting a particular lens design and add power. Eye care practitioners are therefore advised to assess pupil diameter in real life conditions.

Axial movement of the dual-optic accommodating intraocular lens for the correction of the presbyopia: optical performance and clinical outcomes.

Presbyopia occurs in the aging eye due to changes in the ciliary muscle, zonular fibers, crystalline lens, and an increased lens sclerosis. As a consequence, the capacity of accommodation decreases, which hampers to focus near objects. With the aim of restoring near vision, different devices that produce multiple focuses have been developed and introduced. However, these devices are still unable to restore accommodation. In order to achieve that goal, dual-optic accommodating Intraocular Lenses have been designed, whose anterior optic displaces axially to increase ocular power, and focus near objects. Although dual-optic accommodating IOLs are relatively new, their outcomes are promising, as they provide large amplitudes of accommodation and a greater IOL displacement than single-optic accommodating IOLs. The outcomes show comfortable near vision, higher patients' satisfaction rates, and minimal postoperative complications like Posterior Capsular Opacification and Anterior Capsular Opacification, due to their design and material.

[Halos and multifocal intraocular lenses: origin and interpretation]. / Halos y lentes intraoculares multifocales: origen e interpretación.

OBJECTIVE: To present the theoretical and experimental characterization of the halo in multifocal intraocular lenses (MIOL). METHOD: The origin of the halo in a MIOL is the overlaying of 2 or more images. Using geometrical optics, it can be demonstrated that the diameter of each halo depends on the addition of the lens (ΔP), the base power (P(d)), and the diameter of the IOL that contributes to the «non-focused¼ focus. In the image plane that corresponds to the distance focus, the halo diameter (δH(d)) is given by: δH(d)=d(pn) ΔP/P(d), where d(pn) is the diameter of the IOL that contributes to the near focus. Analogously, in the near image plane the halo diameter (δH(n)) is: δH(n)=d(pd) ΔP/P(d), where d(pd) is the diameter of the IOL that contributes to the distance focus. Patients perceive halos when they see bright objects over a relatively dark background. In vitro, the halo can be characterized by analyzing the intensity profile of the image of a pinhole that is focused by each of the foci of a MIOL. RESULTS AND CONCLUSIONS: A comparison has been made between the halos induced by different MIOL of the same base power (20D) in an optical bench. As predicted by theory, the larger the addition of the MIOL, the larger the halo diameter. For large pupils and with MIOL with similar aspheric designs and addition (SN6AD3 vs ZMA00), the apodized MIOL has a smaller halo diameter than a non-apodized one in distance vision, while in near vision the size is very similar, but the relative intensity is higher in the apodized MIOL. When comparing lenses with the same diffractive design, but with different spherical-aspheric base design (SN60D3 vs SN6AD3), the halo in distance vision of the spherical MIOL is larger, while in near vision the spherical IOL induces a smaller halo, but with higher intensity due to the spherical aberration of the distance focus in the near image. In the case of a trifocal-diffractive IOL (AT LISA 839MP) the most noticeable characteristic is the double-halo formation due to the 2 non-focused powers.

La ultrabiomicroscopía en la acomodación / The ultrabiomicroscopy during the accommodation

El objetivo de este estudio es conocer el comportamiento biométrico de las estructuras oculares que participan en la acomodación. Para estudiar los cambios biométricos de las estructuras del segmento anterior del globo ocular, in vivo y durante la acomodación, hemos elegido el ultrasonido de alta frecuencia. Se estudiaron 75 pacientes divididos en 3 grupos, según su rango etario: grupo 1, de 30 a 45 años; grupo 2, de 46 a 60 años, y grupo 3, de 61 a 70 años. Los resultados obtenidos nos muestran cómo varían la forma y la dimensión de las estructuras del segmento anterior y las relaciones entre sí, permitiendo conocer sus comportamientos en la pérdida de la acomodación de los distintos grupos etarios estudiados. Esta técnica permite una evaluación biométrica, morfológica y funcional del segmento anterior, incluyendo la cápsula posterior del cristalino y los cambios del cuerpo ciliar (que no hemos logrado estudiar con otras técnicas). La ultrabiomicroscopía posibilita la visualización durante la acomodación de las cápsulas anterior y posterior del cristalino, la zónula con sus inserciones en la cápsula ecuatorial y el cuerpo ciliar, y la úvea anterior en relación con el cristalino. Las imágenes ultrasónicas obtenidas representan las estructuras del segmento anterior y sus modificaciones in vivo y en tiempo real durante la acomodación. El ultrasonido ha mostrado ser el método diagnóstico más adecuado para esta investigación.

The aim of this study is to understand the biometric behaviour of the ocular structures involved during accommodation. We chose high-frequency ultrasound to study ocular globe anterior segment structures biometric changes in vivo and during accommodation.This technique allows biometric screening, morphological and functional anterior segment, including the posterior lens capsule and changes of the ciliary body that we have failed to study with other techniques. The ultrabiomicroscopy allows visualization during accommodation of the anterior and posterior capsules of the lens, the zonules with insertions in the equatorial capsule and the ciliary body and anterior uvea relative to the lens. The ultrasound images obtained represent the anterior segment structures and their modifi cations in vivo and in real time during accommodation.We studied 75 patients divided into three groups according to age range: Group 1 from 30 to 45 years, Group 2 of 46-60 years, and Group 3 of 61-70 years.The results obtained show how they vary the shape and size of anterior segment structures and relationships with each other, allowing to know their behavior in the loss of accommodation of different age groups studiedUltrasound has proven to be the most appropriate diagnostic method for this research.

La ultrabiomicroscopía en la acomodación

El objetivo de este estudio es conocer el comportamiento biométrico de las estructuras oculares que participan en la acomodación. Para estudiar los cambios biométricos de las estructuras del segmento anterior del globo ocular, in vivo y durante la acomodación, hemos elegido el ultrasonido de alta frecuencia. Se estudiaron 75 pacientes divididos en 3 grupos, según su rango etario: grupo 1, de 30 a 45 años; grupo 2, de 46 a 60 años, y grupo 3, de 61 a 70 años. Los resultados obtenidos nos muestran cómo varían la forma y la dimensión de las estructuras del segmento anterior y las relaciones entre sí, permitiendo conocer sus comportamientos en la pérdida de la acomodación de los distintos grupos etarios estudiados. Esta técnica permite una evaluación biométrica, morfológica y funcional del segmento anterior, incluyendo la cápsula posterior del cristalino y los cambios del cuerpo ciliar (que no hemos logrado estudiar con otras técnicas). La ultrabiomicroscopía posibilita la visualización durante la acomodación de las cápsulas anterior y posterior del cristalino, la zónula con sus inserciones en la cápsula ecuatorial y el cuerpo ciliar, y la úvea anterior en relación con el cristalino. Las imágenes ultrasónicas obtenidas representan las estructuras del segmento anterior y sus modificaciones in vivo y en tiempo real durante la acomodación. El ultrasonido ha mostrado ser el método diagnóstico más adecuado para esta investigación.(AU)

The aim of this study is to understand the biometric behaviour of the ocular structures involved during accommodation. We chose high-frequency ultrasound to study ocular globe anterior segment structures biometric changes in vivo and during accommodation. This technique allows biometric screening, morphological and functional anterior segment, including the posterior lens capsule and changes of the ciliary body that we have failed to study with other techniques. The ultrabiomicroscopy allows visualization during accommodation of the anterior and posterior capsules of the lens, the zonules with insertions in the equatorial capsule and the ciliary body and anterior uvea relative to the lens. The ultrasound images obtained represent the anterior segment structures and their modifi cations in vivo and in real time during accommodation. We studied 75 patients divided into three groups according to age range: Group 1 from 30 to 45 years, Group 2 of 46-60 years, and Group 3 of 61-70 years. The results obtained show how they vary the shape and size of anterior segment structures and relationships with each other, allowing to know their behavior in the loss of accommodation of different age groups studied Ultrasound has proven to be the most appropriate diagnostic method for this research.(AU)

Resultados a largo plazo en pacientes con implante de lente intraocular acomodativo de una optica crystalens HDTM / Long-term results in patients implanted with single-optics intraocular accommodative crystalens HD

Objetivo: evaluar los resultados visuales a 30 + 3 meses del implante binocular del lente intraocular Crystalens HDTM. Diseño: serie de casos. Métodos: en seis pacientes (12 ojos) con implante binocular del lente intraocular Crystalens HDTM se evaluó la agudeza visual no corregida (AVSC), la agudeza visual corregida (AVCC) en visión cercana (40 cm), intermedia (80cm) y lejana (4mts), amplitud de acomodación, test de sensibilidad al contraste, biomicroscopía y encuesta de satisfacción. Resultados: los 6 pacientes evaluados con edades de 62.5 + 16 años presentaron AVSC a 40 cm de +0.1 LogMAR a distancia intermedia de -0.1 LogMAR y a 4 mts fué de 0.0 LogMAR; la AVCC fué de +0.1 LogMAR a 40 cm, 0.0 LogMAR a 80cm y a 4m permaneció sin cambios (0.0 LogMAR). La amplitud de acomodación fué de 4.00 +/- 1.00 dioptrías (D), la sensibilidad al contraste disminuyó en condiciones mesópicas con glare. De los 6 pacientes, 3 (50%) requirieron capsulotomía Nd-YAG laser y sólo 2 (33%) de los pacientes refirieron presencia de halos y glare. Según la encuesta de satisfacción, 5 pacientes (83%) fueron capaces de realizar sus actividades cotidianas sin dificultad ni requerimiento de corrección. Conclusión: el lente intraocular acomodativo de una óptica Crystalens HDTM logra resultados visuales adecuados a distancia lejana e intermedia, requiriendo +0.65 D (rango +0.50 a +1.75) de adición para cerca. En condiciones mesópicas presenta bajo desempeño y presenta un alto porcentaje de opacidad de capsula posterior.

Purpose: to evaluate the visual outcomes of intraocular lens Crystalens HDTM after 30 months of binocular implantation. Design: case series. Methods: in 6 patients (12 eyes) with binocular implant of Crystalens HDTM, we assessed uncorrected (UVA) and corrected (CVA) visual acuity at near (40 cm), intermediate (80cm) and distance (4m), accommodative amplitude, contrast sensitivity, biomicroscopy and satisfaction survey. Results: age of six evaluated patients was 62.5 + 16 years, mean UCVA at 40 cm was +0.1 LogMAR, at intermediate was -0.1 LogMAR and distance VA was 0.0 LogMAR. Mean BSCVA was 0.0 LogMAR at 40 cm, 0.0 LogMAR at 80cm and remained unchanged at distance (0.0 LogMAR). The accommodative amplitude was 4.00 + / - 1.00 diopters, the contrast sensitivity was diminished under mesopic conditions with glare. Of the 6 patients, 4 (66%) patients required Nd-YAG laser capsulotomy and only 2 (33%) of the patients reported presence of halos and glare. Regarding satisfaction survey, 83% were able to perform daily activities without difficulty or correction requirement. Conclusions : the intraocular accommodative lens Crystalens HDTM, restores distance and intermediate vision requiring +0.65 D (range +0.50 to +1.75) at near distance. There is low vision quality under mesopic conditions and a high percentage of posterior capsule opacity.

Monovisión con láser de excímeros en pacientes présbitas / Monovision with Excimer laser surgery in presbyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía con láser de excímeros en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, longitudinal prospectivo, con 60 pacientes, 18 miopes y 42 hipermétropes sometidos a cirugía con láser de excímeros para corregir la presbicia con el método de la monovisión en el Servicio de Córnea y Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ellas (lejos y cerca), y equivalentes esféricos. Para presentar la información se utilizó la media y desviación estándar de ambas. RESULTADOS: En el preoperatorio se observó que la agudeza visual promedio mejoraba de un valor de 0,1 y 0,3 sin corrección para miopes e hipermétropes, respectivamente a 0,94 y 0,97 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, lo cual corrige de esta manera equivalentes esféricos promedios de -4,63 dioptrías y +2,21 dioptrías en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 1 - 2 y los equivalentes esféricos promedios alcanzados para visión lejana fueron de -0,02 ± 0,27 dioptrías para miopes y +0,09 ± 0,34 dioptrías para hipermétropes; en visión cercana, o sea, en el ojo no dominante fue de -1,7 ± 0,22 dioptrías para el primer grupo y de -1,4 ± 0,38 dioptrías para el segundo grupo. CONCLUSIONES: Se halló mejoría de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias con la precisión en los resultados visuales antes previstos que caracterizan a la cirugía con láser de excímeros

OBJECTIVES: To describe the refractive results achieved with Excimer laser surgery in presbyopic patients, both hyperopic and myopic, with monovision. METHODS: A prospective, longitudinal and descriptive study was performed on 60 presbyopic patients, 18 myopic and 42 hyperopic, who underwent Excimer laser surgery to correct presbyopia based on the monovision method at the Corneal and Refractive Surgery Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables used were pre- and post-operative visual acuity with correction, visual acuity without binocular correction, both near and distant, and spheral equivalents. For presenting this information, the mean and standard deviation were used for all variables. RESULTS: In the preoperative phase, it was observed that average visual acuity improved from 0,1 and 0,3 for myopic and hyperopic patients without correction, to 0,94 and 0,97 binocular visual acuity without correction for the same groups in the postoperative phase, thus correcting their average spherical equivalent of 4,63 D and +2,21 D respectively. Average near visual acuity for both groups was Jeager (J) 1 - 2 and average spheral equivalents reached for distant vision were 0,02 ± 0, 27 D for myopic and +0.09 ± 0,34 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1.7 ± 0,22 D for myopic and 1.4 ± 0,38 D for hyperopic patients. CONCLUSIONS: After surgery both myopic and hyperopic patients experienced improvement in their visual acuity without correction for distant as well as for near vision. Spheral equivalents were widely modified in both groups for the dominant and non-dominant eyes, in order to facilitate the final visual result in both distances with the foreseen precision in the visual results that characterizes the Excimer laser surgery

Monovisión con lente intraocular monofocal en pacientes présbitas / Monovision with monofocal intraocular lens in prebyopic patients

OBJETIVO: Describir los resultados refractivos obtenidos mediante la cirugía del cristalino en pacientes présbitas hipermétropes y miopes con monovisión. MÉTODOS: Se realizó un estudio descriptivo, prospectivo, longitudinal con 21 pacientes, 13 miopes y 8 hipermétropes sometidos a cirugía del cristalino para corregir la presbicia con el método de la monovisión en el Servicio de Microcirugía del Instituto Cubano de Oftalmología Ramón Pando Ferrer entre febrero del 2009 y febrero del 2010. Las variables utilizadas fueron: agudeza visual con corrección preoperatoria y posoperatoria y sin ella, lejos y cerca, y equivalentes esféricos. Se utilizó la media y desviación estándar para presentar la información. RESULTADOS: En el preoperatorio la agudeza visual promedio mejoraba de un valor de 0,7 y 0,9 corregida para miopes e hipermétropes respectivamente a 0,88 y 0,94 de agudeza visual binocular sin corrección para estos mismos grupos en el posoperatorio, corrigiendo de esta manera equivalentes esféricos promedios de -8,27 D y +6,26 D en cada grupo. La agudeza visual cercana promedio para ambos grupos fue de Jeager 2 y los equivalentes esféricos promedios alcanzados para visi¾n lejana fueron de -0,32 D para miopes y +0,26 D para hipermétropes; en visión cercana, o sea, en el ojo no dominante es de -1,6 D para el primer grupo y -1,3 D para el segundo grupo. CONCLUSIONES: Se halló mejoría indudable de la agudeza visual sin corrección tanto para la visión lejana como para la cercana después de la cirugía. Los equivalentes esféricos fueron ampliamente modificados para ambos grupos tanto en los ojos dominantes como en los no dominantes para facilitar el resultado visual en ambas distancias. Los resultados obtenidos corroboran que la monovisión produce un mayor beneficio en la visión cercana que el perjuicio que provoca en la visión lejana lo que la hace muy exitosa para cierto grupo de pacientes

OBJECTIVES: To describe the refractive results achieved in presbyopic patients, both hyperopic and myopic, with monovision METHODS: A prospective, longitudinal and descriptive study was carried out in 21 patients, 13 myopic and 8 hyperopic, who underwent lens surgery to correct presbyopia based on the monovision procedure at the Microsurgery Service of the Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2009 to February 2010. The variables were pre and postoperative visual acuity with/without correction, both near and distant, and spheral equivalents. Mean and standard deviation values were used to present all variables. RESULTS: It was found that average visual acuity with correction improved from 0,7 and 0,9 in myopic and hyperopic patients respectively to 0,88 and 0,94 of binocular visual acuity without correction in the postoperative phase, thus correcting their average spheral equivalents of 8,27 diopters (D) and +6,26 D in each group. The average visual acuity for near vision for both groups was Jeager (J) 2 and the average spheral equivalents reached for distant vision were -0,32 D for myopic and +0,26 D for hyperopic patients. For near vision, i.e. in the non- dominant eye, the spheral equivalent values were 1,6 D for the first group and 1,3 D for the second group. CONCLUSIONS: After surgery there was an undoubted improvement in visual acuity without correction, in near as well as in distant vision. Spherical equivalents were widely modified for both groups in both the dominant and the non-dominant eye, improving vision at both distances. The achieved results corroborate that the benefits brought about by monovision in near vision are more important than the damages it causes in distant vision, making it very successful for certain groups of patients