When our “OKULISTYKA 21” Foundation for the Development of Ophthalmology was planning its first symposium on presbyopiawhich took place in Poznań, Poland in November 2017, we came up with the idea to talk about presbyopiaWe asked them what presbyopia is and what methods for correcting it they know — assuming that they surely know quite a lot about it, since it is so prevalent all over the world and affects so many of us and our relatives in our daily lives. We could not have been more wrong! Presbyopia with other visual defects, and the most commonly cited correction method was buying non-prescription “reading glasses” at a drugstore. Even a junior doctor, when asked about methods for presbyopia correction, answered with hesitation: “I would say… eyeglasses?”. This survey clearly showed us that both patients and physicians in Poland needed education, and that it was up to us to get to work and share all of our knowledge on presbyopia.
A global problem
In 2012, approximately 1.7 billion people worldwide were affected by presbyopia. This number is expected to grow up to 2.1 billion by the year 2020. These figures make it clear that presbyopia is a challenge for the future. But what exactly is presbyopia?
Presbyopia is a deterioration of vision resulting from decreased lens flexibility and loss of accommodation ability. Imagine you are squeezing a rubber ball in your hand. When it is new, and your hands are young and strong, this is easy. Over time, as your muscles weaken with age, and the rubber degenerates and becomes more rigid, the task becomes more difficult. Likewise, presbyopia results from your body’s natural aging process. It commonly affects people over 40— those who had never had any problems with vision as well as those with near- or far-sightedness. At first, the lens deteriorates suddenly, and accommodation loss is considerable. Then, it progresses more slowly. Every 2–3 years, the accommodation range decreases by 0.5 or 0.25 diopters, meaning that objects have to be further and further away to be seen clearly.
The first signs of presbyopia you will notice might be headaches, eye fatigue, and having to hold your reading material further away to see it clearly. You may find your vision is blurry e.g. when texting on your phone or reading the paper. Sometimes presbyopia is accompanied by diplopia, or double vision, caused by impaired function of the muscles surrounding the eyeball. In consequence, activities that used to be easy and intuitive become problematic. Now imagine you are an accountant, or a teacher taking attendance, and one day you find “your arms have become too short”! If you are middle-aged and have noticed similar symptoms, it is a sign you should visit an ophthalmologist or optometrist.
Regularly spending multiple hours in front of a screen is a major risk factor for presbyopia. Its development can also be accelerated by taking antidepressants and antihistamines. Research also shows that presbyopia progresses faster in people with diabetes, especially when poorly controlled.
Multiple methods for presbyopia correction exist. First choices include progressive eyeglass lenses and multifocal contact lenses. These two methods are the most popular. Lens or cornea surgery can also be performed. If you notice presbyopia symptoms, it is important to visit an ophthalmologist or optometrist, who will help you choose the right correction method.
Presbyopia can also be corrected surgically during cataract treatment. Cataracts, occurring mostly in older individuals, cause the lens to become opaque, so it has to be removed by phacoemulsification (i.e. broken down using ultrasound). The removed lens is replaced with an artificial implant. Patients undergoing this surgery may receive a monofocal or multifocal lens. A monofocal lens replaces the cataractous lens and ensures good distance vision — which means you still have to wear glasses for near vision. Technologically advanced anti-presbyopic lenses correct vision at all distances (near, intermediate, and distance vision), so you can e.g. work comfortably on a computer. They usually provide very good quality of distance vision, but only reasonable near vision, sufficient for basic tasks such as answering your phone or checking prices at the store. For longer periods of reading, you may still need glasses. If you have presbyopia and another visual defect, you can undergo laser corneal surgery.
More and more people worldwide choose to have their own, unopacified lens replaced with an artificial multifocal lens to correct refraction errors (especially high myopia), presbyopia, or both. Thanks to advances in lens surgery, resulting in increased accuracy and fewer complications, these types of procedures are becoming an increasingly preferable alternative. Interestingly, the method was invented by a Pole, Wincenty Fukała, in the 1880s, and is known as “Fukała’s operation”. Of course, intraocular lenses were not yet known in his times, and the procedure was only performed for refractive correction.
There are also two main concepts of pharmaceutical presbyopia correction. One involves narrowing the pupil, creating an optical setting favoring better vision. The vision improvement achieved this way is partial, temporary, and associated with certain side effects, such as headaches and poorer vision under low light conditions. The other method involves using pharmaceuticals to increase the flexibility and accommodation ability of the lens. This category includes a drug known as “EV06”. EV06 eye drops are now undergoing clinical trials, but initial results are quite promising, especially for mild and moderate presbyopia. Importantly, the method is noninvasive and no serious side effects have as yet been observed.
In summary, a number of methods are now available for managing presbyopia. They may be noninvasive — like selecting and buying appropriate progressive glasses or multifocal contact lenses — or invasive, like intraocular lens implantation (e.g. during cataract surgery) or laser correction (combined with correction for refractive errors).
Polish “Presbyopia 21” Club
The need for education is enormous. New technologies are both a blessing and a challenge to all physicians taking care of their patients’ eyesight. In April 2016, a new initiative — the Polish “Presbyopia 21” Club — was launched in Poznań, Poland. The club, headed by Professor Andrzej Grzybowski, has undertaken numerous projects to promote knowledge and raise awareness among physicians and their patients. On September 12, 2020, the fourth edition of our Presbyopia scientific conference is taking place, with contributions from leading Polish ophthalmologists, sharing their expertise on presbyopia.
The Polish “Presbyopia 21” Club has also created the first Polish educational platform on presbyopia, dedicated to patients and ophthalmologists. At www.prezbiopia.pl, patients can find information on all available methods for presbyopia correction, as well as discussions and opportunities to exchange knowledge and experiences with other users.
The Polish “Presbyopia 21” Club has also launched efforts to develop, in cooperation with leading Polish experts, standards for each of the four top methods of presbyopia correction, i.e. progressive eyeglasses, contact lenses, corneal refractive surgery, and intraocular surgery. If you are interested in the Club’s activities and want to support us, follow our Facebook page — Presbiopia21.
Professor Andrzej Grzybowski, MD, PhD – Head of the Ophthalmology Department at the University of Warmia and Mazury in Olsztyn and Chair of the “OKULISTYKA 21” Foundation for the Development of Ophthalmology (http://okulistyka21.pl/). Chair of the Polish Scientific Committee of the Polish “Presbyopia 21” Club. He has won prestigious national and international academic awards. In 2017, in recognition of his scientific accomplishments, he received the Achievement Award from the American Academy of Ophthalmology. Member of multiple scientific societies, including the European Association for Vision and Eye Research (EVER), European Society of Cataract and Refractive Surgeons (ESCRS), European Academy of Ophthalmology (EAO), American Academy of Ophthalmology (AAO), and board member in the European Society of Retina Specialists (Euretina). He has published more than 350 scientific papers in peer-reviewed international journals. He has co-authored the books “OCT in Central Nervous System Diseases. The Eye as a Window to the Brain” (2016) and “Endophthalmitis in Clinical Practice“ (2017).