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Dorian Gray sold his soul to the devil in the name of his youth, today we are consulting an aesthetic medicine doctor to get rid of wrinkles. But what about a lens that loses its elasticity over time and gives away our age? With the ophthalmologist prof. Andrzej Grzybowski, head of the Department of Ophthalmology UWM in Olsztyn, we talk about how to say goodbye to presbyopia once and for all.
Professor, is everyone doomed to presbyopia?
prof. Andrzej Grzybowski: Unfortunately, the problem of presbyopia, otherwise known as presbyopia, affects everyone, both people with myopia, hyperopia, and those who have had no problems with eyesight in the past. It is estimated that by 2020, the number of people struggling with presbyopia in the world will be around 1,3 billion!
Still, for the “average Smith”, presbyopia is a big question mark.
In order to spread knowledge on this subject, a new initiative was created – the Polish Presbiopia 21 Club, bringing together both Polish and international experts. The mission of the Club, of which I am honored to be the chairman, is to educate patients and ophthalmologists in the field of up-to-date solutions for the correction of presbyopia. As part of its activities, we organize workshops and educational and discussion meetings, and in the near future we plan to create a separate internet platform dedicated exclusively to presbyopia. Already now, I cordially invite doctors and optometrists to take part in the November conference “Presbiopia 2017”, which will be held in Poznań.
One of the symptoms of presbyopia is “hands too short” – what is it?
Presbyopia is the deterioration of eyesight due to the stiffening of the lens and the deteriorating accommodation capacity of the eye. Figuratively speaking, imagine that you are squeezing a rubber ball in your hand. When it is new, and the hand is young and strong, we do not have the slightest problem with this activity, but with time the hand muscles weakened with age are not able to squeeze it as tightly as they used to. In turn, the material from which the ball is made, also with old age, deforms more and more difficult. Presbyopia is a natural process that most often affects people over the age of XNUMX. The first stage of lens aging occurs abruptly, and the loss of accommodation is evident. Over time, the defect deteriorates less rapidly. Every two or three years there is a loss of visual acuity by a quarter or a half diopter. One of the first symptoms is difficulty seeing clearly up close, which is when everyday activities such as reading the newspaper or using a mobile phone become a nuisance. At first, we move objects away from each other to see better. Unfortunately, our hands become too short with time.
What other symptoms should worry us?
Moving the text away so that it is legible, headache and eye fatigue when we look closely in middle age are symptoms that should prompt us to test our eyesight. Presbyopia is sometimes accompanied by diplopia, i.e. double vision of objects, in this case caused by a malfunction of the external muscles of the eyeball.
Age is a major risk factor, but what else affects how quickly our eyes age?
Regular and long-term work in front of the monitor, taking antidepressants and antihistamines, inadequate diet or stimulants all have an impact on the condition of our eyes. Research shows that presbyopia develops faster in people with diabetes, especially if it is poorly controlled.
How is presbyopia different from hyperopia?
Presbyopia is not a disease, temporary ailment, or a defect. It is a natural evolution of the organ of vision, inscribed in human physiology. Hyperopia, also known as hyperopia, is a refractive error. It involves the optical system of the eye focusing parallel light rays behind the retina, not on it. Most often it is caused by too weak breaking power of the optical system or too short the eyeball.
Reading glasses are the standard treatment, what else can we do?
We have many different ways to correct presbyopia, non-invasive and surgical. The former are progressive glasses and multifocal contact lenses. Surgical treatments are treatments on the cornea and lens of the eye.
What are they about?
Presbyopia can be eliminated surgically during cataract surgery. Cataracts that affect mainly elderly people, i.e. lens clouding, are removed using the phacoemulsification method, which consists in breaking the cloudy lens with ultrasound. The broken lens is removed and replaced with an artificial implant. The patient is implanted with one of two types of lenses: single or multifocal. Single vision lenses, apart from cataract removal, ensure good quality of far vision. For near vision, it is then necessary to wear corrective glasses. But already technologically advanced anti-presbyopic lenses improve vision across the entire spectrum, i.e. distance, near and intermediate distances, including computer work. They usually allow very good distance vision, good indirect vision, and sufficient near vision to perform basic tasks such as answering the phone, reading text messages, checking the store price up close without glasses. However, reading for longer periods may require the use of glasses. In the case of coexistence of visual impairment with presbyopia, it is possible to use laser corneal surgery, similar to refractive laser treatments such as LASIK.
More and more people around the world are also choosing to have their own clear lens replaced with an artificial multifocal lens for refractive, anti-prescription or both. Due to the increasing accuracy and decreasing complications of lens surgery, this type of surgery is becoming an increasingly interesting alternative to other options. Interestingly, this operation was invented by a Pole, Wincenty Fukała in the 80s and is known as the “Fukała operation”. Of course, in his time there were no intraocular lenses yet and then the procedure was refractive, i.e. it corrected high myopia.
Can eye drops be a breakthrough in the treatment of presbyopia?
There are currently two main strategies for the pharmacological treatment of presbyopia. The first is to reduce the pupil diameter and create optical conditions for better vision. The improvement in vision is temporary, partial, and is associated with side effects including headache and worse twilight vision. The second method is the use of pharmacological agents that make the lens more flexible and prone to deformation. The EV06 belongs to this group. EV06 eye drops are still in clinical trials, but preliminary research results are fairly successful, especially in mild to moderate presbyopia. Importantly, it is non-invasive and no serious side effects have been reported so far.
Recently, there has been a lot of talk about state-of-the-art corneal implants.
Yes, for example, Kamra implants are the first implant of this type intended for patients aged 45 to 60 years. They are used in 49 countries around the world and have already been implanted in over 20 patients worldwide. The device works by correcting the focusing of light rays inside the eye, and more precisely, it reduces the amount of light hitting the retina through the periphery of the pupil. In this way, the Kamra insert eliminates those rays that the lens of a presbyopic person is unable to properly focus. American studies conducted on 000 people over the year prove the effectiveness of the implant in nearly 478 percent. of them. The implant is in the form of a thin, flexible disc with a diameter of 85 mm with a 3,8-mm hole in the center. The entire procedure of inserting the implant takes about 1,6 minutes.
Prof. extra dr hab. med. Andrzej Grzybowski – Head of the Department of Ophthalmology at the City Hospital in Poznań and Head of the Department of Ophthalmology at the University of Warmia and Mazury. Laureate of prestigious domestic and foreign scientific awards. Decorated by the President of the Republic of Poland with the Knight’s Cross of the Order of Polonia Restituta, and earlier with the Bronze and Silver Cross of Merit. Member of many scientific societies, including the European Society for the Examination of the Eyesight (EVER), the European Society for Cataract and Refractive Surgery (ESCRS), the American Academy of Ophthalmology (AAO), board member of the European Retinology Society (Euretina). Author of over 350 scientific articles in peer-reviewed international scientific journals, including New England Journal of Medicine, Ophthalmology, Retina, Acta Ophthalmologica, Survey of Ophthalmology, British Journal of Ophthalmology. Member of the editorial board of many scientific journals: Acta Ophthalmologica (IF 3,0), Clinics in Dermatology (IF 2,4), Graefe’s Archive for Clinical and Experimental Ophthalmology (IF 1.99), Neuro-Ophthalmology (IF 0,161), Saudi Journal of Ophthalmology, Asia Pacific Academy of Ophthalmology Journal (APAO Journal), Archives of the History and Philosophy of Medicine (editor-in-chief), Historia Ophthalmologica Internationalis (editor-in-chief) and Frontiers in Neurology (Neuro-ophthalmology Section, IF 3,2). Co-author of the book entitled OCT in Central Nervous System Diseases. The Eye as a Window to the Brain ”. President of the Foundation for the Development of Ophthalmology «Ophthalmology 21» (http://okulistyka21.pl/).