ELDERLY FARSIGHTEDNESS OR SENILE DIOPTER
Presbyopia is one of the common problems that occur in the forties.
Nowdays – number of the possible treatment modalities, other than glasses, increases.
Presbyopia or Age Related Farsightedness, what exactly troubles us in adulthood?
Just like wrinkles appear on the face or gray hairs on the head, one of the first signs of aging is the onset of vision impairment – what is expertly called presbyopia. Ordinary reading requires effort. The letters get blurred and book or the paper must be moved away form the eyes for easier reading.
When does the Age-Related Farsightedness Appear?
It usually occurs after the age of 40. The average age of the population in Croatia is 41 years, so presbyopia is a problem affecting the majority of the Croatian population. Over one billion people in the world are presbyopic.
Symptoms of presbyopia or age-related farsightedness?
The first symptoms in most people: inability to read fine print, especially in dimmed light conditions, eye fatigue on prolonged reading, blurry vision or immediate blur when changing different viewing distances (feeling that the hands are “too short”).
What Causes Presbyopia?
Presbyopia or age-related farsightedness is a process primarily related to age-related changes in the lens of the eye – the natural translucent lens in the human eye. The function of the eye lens is to focus on close objects (just like with a lens in a camera lens), which requires changing the shape of the lens (i.e. accommodation of the eye), as well as the contraction and relaxation of the muscles and ligaments in the eye associated with the lens. Over time, the lens becomes thicker and more inflexible, eye muscles get weaker, which is manifested by the increasing difficulty seeing objects at close distances, or farsightedness.
Can Presbyopia Be Prevented?
There is no cure for presbyopia. It is possible to take care of the health of the eye with a healthy diet and lifestyle but it is not possible to prevent presbyopia. Only the consequences of this condition can be treated. Poor near vision is usually successfully corrected with glasses or contact lenses.
As the eye lens becomes less elastic over time, so does the amount of necessary diopter correction increases, which ranges from about +0.50 D for initial presbyopia to near +3.00 for people over 65 years of age.
GLASSES
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With the onset of age-related farsightedness, ophthalmology specialist determines an additional reading prescription to the existing distance prescription. Usually, single-prescription reading glasses are sufficient for most close-up jobs, but they are impractical because they require constant placement and removal. In addition, they provide clear vision only at readable distances (approx. 40 cm), while vision at distances of 1-2 meters is still blurred.
Often this is why the other kind of glases are suggested, such as bifocal (two different prescriptions in one pair of glasses) or progressive glasses (more prescriptions in one pair) – so that the vision problem at different distances can be solved.
Does wearing reading glasses impairs vision?
Wearing glasses does not aggravate presbyopia with the proper prescription. However, people become accustomed to clearer vision with glasses and subjectively it becomes more difficult to see without them.
CONTACT LENSES
Those who do not wear glasses may opt to use bifocal or multifocal contact lenses. In practice, contact lenses help a relatively smaller number of people because it takes time to get used to them. In addition, putting on, removing, and storing contact lenses is an extra work.
Does wearing a lens cause a dry eye?
Wearing contact lenses should be taken seriously and follow the instructions of a physician. The tear film becomes weaker while wearing contact lenses and they must always be removed from the eye before bedtime.
LASER VISION CORRECTION
Modern lasers in eye surgery can very accurately reshape the cornea (frontal transparent part of the eye). This allows partial or complete correction of the refractive error of the eye, such as nearsightedness, farsightedness and astigmatism.
It is also possible to solve the problem of presbyopia using the monovision method. It is a method of vision in which laser correction is performed in such a fashion, that one eye is corrected to see distant objects well and the other one is corredcted ro see at a reading distance.
SURGICAL CORRECTION OF ELDERLY FARSIGHTEDNESS WITH INLAYS
Inserts are a minimally invasive and very comfortable way for the patient to remove presbyopia.
Currently, the most popular three types of inserts are:
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Kamra inlay – a solution to senile farsightedness. It is a small ring with a diameter of 3.8 mm and a thickness of only 5 microns, which is installed in a "pocket" created by a laser in the cornea and enables clear vision at close and intermediate distances (monitor).
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Raindrop - an insert with a diameter of 2 mm and a thickness of 32 microns made of hydrogel, which, like an implantable contact lens, provides clear vision
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Flexivue Microlens – a microlens made of hydrophilic polymer with a diameter of 3 mm and a thickness of 15 microns at the edges
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MULTIFOCAL LENS IMPLANTATTION IN THE EYE – PERMANENT VISION SOLUTION AT ALL DISTANCES
What is an intraocular lens (IOL)?
An intraocular lens is a soft polymer implant – silicone or acrylic, technologically sophisticated, which is implanted in the eye to enhance vision.
When is intraocular lens implanted in the eye?
During the cataract surgery, a natural lens which became non transparent is removed from the eye and an artificial intraocular lens is implanted to provide clear, distant vision.
Successful implantation of an intraocular lens requires accurate measurement of IOL refractive power prior to surgery and consultation with the surgeon on choosing the best possible lens for one˙s individual needs.
TYPES OF INTRAOCULAR LENSES
Monofocal lenses
Traditional monofocal (single refractive power) IOL focuses the beam of light from the distance in a single point, allowing for excellent long-distance vision. After the implantation of such lens, it is necessary to wear goggles when looking at proximity because of the inability to accommodate; exception is monovision – implantation of monofocal IOL for clear distance vision in the dominant eye and monofocal IOL for clear vision for proximity to the non-dominant eye). The lens design can be spherical or aspherical. Currently, the highest quality lenses on the market include a UV filter and a blue light filter, thus protecting the macula from degenerative changes.
Toric monofocal IOLs are a new generation of cylindrical intraocular lenses that, in addition to the usual spherical diopter, can correct astigmatism, thereby improving the quality of vision in patients with astigmatism.
Multifocal lenses
The multifocal lens is specifically designed to create better vision at different distances and mimics natural accommodation, i.e. clear distance and close vision that makes the patient independent of glasses and contact lenses.
Successful implantation of a multifocal intraocular lens requires accurate measurement of IOL power prior to the surgery, optical biometrics and accurate central placement of the IOL during the procedure. Our Clinic has been performing such surgery for many years and is following trends in world eye surgery with continuous education of its doctors.
There are several types of multifocal intraocular lenses:
Toric monofocal IOLs are a new generation of cylindrical intraocular lenses that, in addition to the usual spherical diopter, can correct astigmatism, thereby improving the quality of vision in patients with astigmatism.
Refractive
Intraocular lenses operate on a similar principle to multifocal contact or eyeglass (progressive) lenses, with three zones simultaneously providing close, medium and long distance vision.
Advantages and disadvantages of a refractive multifocal lens
Refractive multifocal IOL provides excellent visual acuity over medium and longer distances. The visual acuity at close range is good, but may not be sufficient to read very small letters, which can be corrected by reading glasses in the case of urgent need. According to studies, about 25% of patients with implanted refractive multifocal IOL initially notice milder glare and haloes around the light source. This can cause mild problems when driving at night. Most patients become accustomed to this phenomenon of glare that becomes imperceptible over time. It is important to note that 7-8% of patients with standard monofocal lens implantation also experience glare and haloes.
Diffractive
Intraocular lenses represent the greatest technological achievement among intraocular lenses due to their good visual acuity at close and at the distance. The lenses can be BIFOCAL and TRIFOKAL, depending on how much clear vision focus they provide after implantation.
SYMFONY INTRAOCULAR LENS
Symfony intraocular lens is the latest product from Abott Medical Optics with the so-called extended range of vision. With this technology, they have been able to minimise all the shortcomings of classic multifocal lenses, such as glare, haloes and low contrast.
Accomodative monofocal lenses
Designed in fashion to move forward with the action of a ciliary and vitreous body – during focusing. Experience has shown that patients with a built-in accommodative lens can achieve only 1.0 – 2.5 diopters of accommodation, which does not allow them to see perfectly at close distances.
Can I get a cataract after the lens is implanted?
Once the intraocular lens is inserted, you can no longer get a cataract. This is one of the bigger motives why people decide to have a surgery because it prevents possible eye surgery in the future.
Is it possible that one may experience change of refractive error after the lens has been implanted?
After the lens is inserted into the eye, the refraction does not change and remains stable for the rest of its life. The durability of the results is due to the fact that the multifocal lens does not depend on the natural accommodation of the eye, which weakens over time. This is a big argument compared to a laser monovision where the refractive error deteriorates and the effect of the surgery weakens over time.
PRESBYOPIA OR AGE-RELATED FARSIGHTEDNESS IN KNEZOVIC EYE INSTITUTE
Lens replacement surgery
The Knezovic Eye Institute has continuously performed the most complex procedures for the implantation of multifocal lenses in the eye for many years. Thousands of people have had successful surgeries. We use state-of-the-art diagnostic and surgical technology. Adequate equipment, many years of experience, surgeon˙s medical knowledge and the entire medical team dedication are required to perform successful surgery.
Which lens do I opt for?
The type of lens that is ideal for an individual depends on a number of factors that are determined after the examination. Some of the most important ones are: eye health, patient age and profession. Your doctor will explain in detail which lens is ideal for you and will be happy to answer any questions you may have.
When is the earliest recommended surgery for presbyopia?
The surgery is not recommended for people under 50 years of age. The reason is that there is still natural accommodation of the eye.
Preparing for the surgery
The eye drops that dilate the pupils are applied when patient arrives to the Clinic. Eye pressure and blood pressure are measured and the patient is examined on the slit-lamp.
After about an hour (depending on how fast pupils dilate), the patient is ready to go to the operating room. In the operating room, the patient is comfortably placed on the operating table, which is soft and movable in multiple directions to ergonomically adapt to each patient.
Nurses disinfect the skin around the eyes, put a sterile patch over the patient, and place an eyelid holder that helps the patient not to blink. The eye is anesthetized with eyedrops and there is no need for general anesthesia. No injections are given and the procedure is completely painless.
Surgical procedure
The surgery itself lasts about 10 minutes. The patient looks at the light source and is constantly awake and communicating with the surgeon. Since surgery is painless and fast, most patients are surprised that everything has passed so quickly and easily, and that all the fears that people usually have before the procedure were unnecessary.
The procedure is performed through a small incision only 2 mm wide, without the need for sutures or any injection. At the end of the procedure, the lens is implanted in the eye, which also enters the eye through the small incision and unfolds in the eye. At the end of the surgery, sterile eyepatch is put on the eye and the patient leaves the operating room with a help of medical staff.
After the cataract surgery
About half an hour after surgery, the patient goes home, warned to avoid greater physical exertion and unfavorable microclimatic conditions (wind, dust, smoke). Check-up examination is scheduled next morning.
Three hours after surgery
Sterile eyepatch may be removed from the eye. Except for the first check-up examination the next day, it is recommended to have a check-up one-month after the surgery (when glasses are prescribed if needed). Regular control follow-up of the patient are scheduled 6 months and a year after the surgery.
Cataract surgery complications
Every surgical procedure may have potential complications such as eye infections, damage to the eye tissues during surgery, etc. With modern technology and ultrasonic devices that release minimal amounts of ultrasonic energy and maintain stable eye pressure, complications are extremely rare.
IGOR KNEZOVIC, MD, Ph.D. - THE SURGEON
Dr. Knezovic has been educated as an eye doctor at several centers of excellence for ultrasound cataract surgery, such as Munich, USA, Columbia, India (personally trained by Dr. Agarwal, one of the most famous eye surgeons in the world).
He introduced the “karate chop” technique in the Republic of Croatia, which is characterised by extremely precise lens division technique. This further reduces the need for the use of ultrasound, which is especially important in hard lenses and complicated cases. At the Knezovic Eye Institute, he personally performs all cataract / lens replacement surgeries and laser vision corrections.
As an eye doctor, Dr. Knezovic introduced ultrasound cataract surgery at Clinical Hospital Dubrava where he worked for 5 years, performed thousands of surgeries and trained other colleagues on this advanced technique. It is important to emphasise that in addition to cataract surgery and the implantation of multifocal lenses.
Dr. Knezovic also successfully performs laser refractive surgery, which may be important if any refractive error appears after surgery. Many patients come for a second opinion because of the inaccurately calculated lenses and therefore the unsuccessful operations, and in this case we can help them with laser corrections.