What is presbyopia and what causes it?
Presbyopia is nothing more than the physiological loss of the eye’s ability to focus, commonly known as eyestrain. The eye behaves like a camera where it has a focusing system and this focusing system, after a certain age, degenerates and is lost. The crystalline lens, which with its movements is what makes the focus, the muscle that is in charge of making the lens focus, becomes exhausted. This leads to what is called presbyopia or eyestrain, that is, an inability to focus on objects at a certain distance. The main cause is nothing more than the exhaustion of this muscle due to age. This is why presbyopia generally occurs and appears from the age of 40, 42 years old and is progressive until the age of 65.
What are the symptoms?
The main symptoms of presbyopia, as we have said before, there is a depletion of the muscle that is dedicated to focus and, therefore, we begin to have problems in reading. In patients who do not have any defect of distance glasses this usually happens between 40, 42 years old and it is usually progressive and it becomes maximum at 50, 55 years old. So we have to wear corrective glasses to make up for the degeneration effect of this “little muscle” that prevents us from focusing. In patients who are myopic, technically it is curious, the myopic patient sees well up close, but poorly at a distance, so he starts to take off his glasses at a distance in order to see well up close. And those who are farsighted, the problem comes before they are even 40 or 42 years old, they begin to have a problem at distance and this problem at distance increases at near from the age of 35 or 36 years old.
What are the treatments for presbyopia like?
Many medical treatments with vitamin complexes have been tried for the treatment of presbyopia. Presbyopia is nothing more than an involutive and degenerative process after a certain age, so vitamin treatments have not been successful. The treatment par excellence of presbyopia, of eyestrain, is to correct this defect of focus with glasses, that is, at 42 years of age we need, we have lost a focus of one diopter, so we have to correct it with glasses of one diopter, that is why we put on a pair of glasses and with that we can read. From 42 to 65 years of age, we have to increase the prescription we have to correct as the focusing defect increases, so it varies from one diopter at 40 – 42 to two and a half or three diopters at 60 – 65 years of age.
What about surgical treatment?
Regarding the surgical treatment of presbyopia, fortunately, for the last 10 or 12 years, we have had surgical treatments for presbyopia. There are two main blocks: laser treatment, which was the first to be tried, which is not useful for all patients, which is not definitive, which consists of trying to achieve mono vision, i.e. leaving one eye myopic for near vision and the dominant eye for distance vision. In some patients it works for a long time, it is a superficial treatment and it is not very aggressive. But by definition, the most definitive treatment for presbyopia is the implantation of diffractive intraocular lenses. What is this? Well, it is simply the removal of the crystalline lens, that lens that is no longer competent, because it no longer focuses, and replacing it with an intraocular lens. But for a progressive intraocular lens, that is to say, it will allow the patient, once operated, to enjoy good distance vision, good intermediate vision for the computer and good near vision without the need to wear glasses. Is this treatment useful for everybody? No, we have to make a very detailed study of each patient, just as we have to make a very detailed study of the lenses on the market that we are going to implant in that patient, because the concept of premium lens, i.e. the best lens for each patient, has to be individualized. But today, with the methods of aberrometry, with the methods we have preoperatively to evaluate which is the patient and the ideal candidate and to evaluate which is the ideal lens for each patient, the degrees of satisfaction are very high. And it is a definitive treatment, that is to say, we have removed the crystalline lens, we have implanted a lens, and there will be no more presbyopia problems because presbyopia will no longer increase.