Innovations in Presbyopia Management Ashok Garg, Dimitrii Dementiev, Roberto Pinelli, Guillermo Avalos Urzua
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1Step by Step Innovations in Presbyopia Management2
3Step by Step Innovations in Presbyopia Management
Editors Ashok Garg MS PhD FIAO(Bel) FRSM FAIMS ADM FICA International and National Gold Medalist Medical Director Garg Eye Institute and Research Centre 235-Model Town Dabra Chowk Hisar-125005 India Dimitrii Dementiev MD Chief and Medical Director Blue Eye Centro di Michrochirurgia Oculare Eye Clinic, Arese 20020 (MI) Via Campo Gallo 21/10 Milan, Italy Guillermo Avalos Urzua MD Chief Ophthalmic Deptt. Sagrado, Corazon Hospital Medical Director Avalos Ophthalmic Institute and Ophthalmic Laser Clinic Terranova No. 676-101 Col. Providencia Guadalajara, Jal, Mexico CP 44630 Roberto Pinelli MD Scientific Director Instituto Laser Microchirurgia Oculare Crystal Palace Via Cefalonia 70 Brescia-25124, Italy Foreword: Marguerite B McDonald
4Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Step by Step Innovations in Presbyopia Management
© 2006, Ashok Garg, Guillermo Avalos Urzua, Dimitrii Dementiev, Roberto Pinelli
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
This book has been published in good faith that the material provided by contributors is original. Every effort is made to ensure accuracy of material, but the publisher, printer and editors will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters are to be settled under Delhi jurisdiction only.
First Edition: 2006
9788180616471
Typeset at JPBMP typesetting unit
Printed at Gopson Papers Ltd, A-14, Section 60, Noida
5Dedicated to
6
7Contributors 11Foreword
Of all visual defects, presbyopia has been most challenging to correct. Partly because the mechanisms of accommodation and the causes of presbyopia are complex. Presbyopia is also unique in that it is only refractive error that is potentially progressive in nature. The correction of presbyopia remains the holy grail of refractive surgery.
As we all know—many of us to our great chagrin—everyone becomes presbyopic with age. Myopes and higher hyperopes who have always worn glasses may adjust well to bifocal or progressive lenses, contact lens monovision, or other non-surgical solutions. Some people simply don't mind taking reading glasses on and off or carrying around multiple pairs of spectacles. But there is a huge population of individuals who are quite distraught by presbyopia as a very tangible reminder of aging. More than 40% of Americans over age 40, for example, are emmetropes or very low hyperopes who have never worn glasses. Many of these individuals, particularly in the baby boomer generation, are actively looking for a surgical fix to give them back the vision they used to have.12
Presbyopia presents challenges for the ophthalmic community. The mechanisms and causes of presbyopia are not fully understood. In fact, competing theories about what is happening to the lens and zonules during accommodation have led to very different supposed cures.
In this Step by Step Innovations in Presbyopia Management book, leading experts from around the world discuss presbyopia as a condition and look at appropriate preoperative evaluation of and considerations in recommending innovative treatments for the presbyopic patient.
In this book, authors explore the rich variety of techniques for correcting presbyopia. These include lenticular, corneal, and scleral approaches to restoring accommodation or pseudo-accommodation. Some of them, including conductive keratoplasty and multifocal LASIK, are in widespread use already. Others are still early in the developmental stages. Although I think it is too soon to tell which approach will ultimately find the greatest success, one can find excellent ideas and pearls from the top authorities on the subject in these pages.
While the idea of restoring true, dynamic accommodation is enticing, it is also probably still a long way from fruition. Many will continue to pursue that challenge; but in the meantime, we have some safe and very effective options on the table for restoring to patients what they liked about accommodation—good 13functional near vision without glasses, and the ability to easily transition from near to distance vision.
I hope you enjoy and learn from this Step by Step handy book, and offer my congratulations to Dr Garg and his fellow editors for their sincere efforts in compiling such a thorough look at presbyopic surgery.
Dr Marguerite B McDonald
md
Clinical Professor of Ophthalmology
Tulane University School of Medicine, USA
Medical Director
Southern Vision Institute
New Orleans, Louisiana, USA.
Tel.: (504) 896-1240
E-mail: margueritemcdmd@aol.com14
15Preface
Presbyopia Management is the ultimate goal for ophthalmologists worldwide. In the 21st century, the innovations and latest developments are taking place in the field of presbyopia. The objective of new innovative techniques is to allow the patient to focus on near objects while retaining his ability to focus on far objects taking into account the refractive errors of the eye when the treatment is performed.
The restoration of reading vision in presbyopia is one of the most important components of modern refractive surgery. For the last five years, a massive innovative work is being done on lenticular, corneal and scleral modifications to correct presbyopia with encouraging results. Multifocal presbyopic LASIK, conductive keratoplasty and multifocal presbyopic lenses are in widespread use already. A lot of work is being done on laser and injectable intraocular lenses for restoration of accomodation with initial success. Use of accommodating implants, multifocal implants, Refractive lens exchange and blended vision implants are lens-based refractive surgery procedures which are quite successful in restoring reading vision in presbyopic patients.
This Step by Step Innovations in Presbyopia Management book has been written through a collective effort 16of leading international presbyopic refractive surgeons with the purpose of providing latest knowledge on modern lens and corneal-based refractive techniques for presbyopia correction to ophthalomologists who are interested in presbyopia surgery practice. Seventeen chapters of this book are written by well-known international refractive surgeons sharing their knowledge and skill covering all aspects of presbyopia management.
We are specially thankful to Shri Jitendar P Vij (Chairman and Managing Director), Mr Tarun Duneja (General Manager, Publishing) and all staff members of M/s Jaypee Brothers Medical Publishers Pvt. Ltd. who extended full cooperation and prepared this high quality international handy book in short time. We are quite hopeful to provide a comprehensive and latest information on presbyopia correction to every interested ophthalmologist and it shall be a useful reference.
Editors