In the following article, the prestigious ophthalmologist, Dr. Carlos Vergés Roger explains the treatment of presbyopia.
What is presbyopia?
Presbyopia is the loss of the ability to focus on near objects. Our visual system has mechanisms that allow us to maintain the focus of objects from a distant position to a near position and vice versa; this is what we call “accommodation”. This situation is due to the action of a muscle-tendon system (ciliary muscle and zonule) acting on the eye’s natural lens, the crystalline lens, which modifies its power and allows the focusing of objects.
This focusing mechanism is progressively lost with age, generally after 40-45 years of age, and this is what we call presbyopia.
What symptoms does it produce in the patient?
The main symptom is the loss of focus on near objects. This sign becomes more evident in poorly lit spaces or when we are more fatigued, and can even affect distant vision, especially when it begins to manifest itself.
How can it be diagnosed?
Generally, the patient usually goes to the ophthalmologist because he/she finds it difficult to visualize near objects, located at 30 – 50 cm. When this visual change occurs, then is when we perform a series of examinations to assess the degree of alteration in accommodation, basically measuring visual acuity, in standard conditions and decreasing contrast sensitivity.
To objectively assess the loss of accommodation, we have new systems that allow us to measure the accommodative capacity, by optical interferometry or by dynamic aberrometry, which are very useful to decide the most suitable method for each patient.
What treatments can be carried out to recover the correct functioning of the crystalline lens?
The recovery of the accommodative capacity, especially of the crystalline lens, is very limited, in fact it is produced by the sclerosis (aging) of its tissues and although there are mechanisms that allow delaying its evolution, it is not known how to definitely stop its aging. At present, a series of exercises can be performed (Visual Therapy) aimed at maintaining the elasticity of the crystalline lens as well as the functionalism of the muscles and ligaments that allow accommodation, but always in a limited way.
For a more definitive and lasting treatment we have other systems available such as: laser corneal reshaping, lens implantation inside the cornea (inlays), intraocular lens implantation or, more recently, the implantation of scleral devices, which have the advantage of not being an intraocular surgery and do not alter the visual axis, thus reducing the risk of complications.
Can anyone undergo surgery?
In order to know if a person is a candidate for surgery, it is necessary to perform a series of tests, not so much to know if he/she can be operated, but to decide which is the best option for that person. Generally speaking, we can say that almost 90% of the population could be operated on, provided that a correct diagnosis is made and the right treatment is applied, with the right technology and an experienced surgeon.
If it is not corrected, can there be any complications?
No, the truth is that presbyopia can still be treated with classic glasses. The disadvantage is that it will depend on a “prosthesis” with the limitations that this entails for activities such as sports, swimming pool, etc.
Is there any way to prevent presbyopia?
We have already said that presbyopia was the aging process of the eye. This is something that we cannot stop completely, but we can delay and minimize it. To do so, it is advisable to limit the action of ultraviolet radiation and the sun, by means of: glasses with filters, a diet rich in omega 3 and low in omega 6, exercises at home to stimulate accommodation and, fundamentally, specific Visual Therapy exercises for each case. Our experience with this type of therapies allows us to prevent the progression of presbyopia.