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Pharmacological Correction of Presbyopia : A preliminary Study

Pharmacological Correction of Presbyopia : A preliminary Study. Claes Feinbaum M.Sc. PhD Professor & Clinical Director Vision4You Lund, Sweden Visiting Professor at Ben Gurion University of the Negev Israel & Medicinski Center Vid Dr. Franc Salamun Dr. Katja Matovic.

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Pharmacological Correction of Presbyopia : A preliminary Study

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  1. Pharmacological Correction of Presbyopia: A preliminary Study Claes Feinbaum M.Sc. PhD Professor & Clinical Director Vision4You Lund, Sweden Visiting Professor at Ben Gurion University of the Negev Israel & Medicinski Center Vid Dr. Franc Salamun Dr. Katja Matovic Eilat January 2014

  2. CurrentProcedures for the Correction of Presbyopia • CornealExcimer Laser Surgery (PresbiLasik) • CornealInlays • IntraCor • SupraCor • MultifocalIOLs • Others Some of theseprocedures are irreversible!!

  3. Reversability Whileexcimer laser ablations from variousmanufacturers (PresbyLASIK, Abbott Medical Optics; PresbyMax, Schwindeye-tech solutions; Supracor, TechnolasPerfect Vision) and femtosecond laser intrastromal ablation (Intracor, TechnolasPerfect Vision) are effectivetreatments in the majority of patients, visualsideeffects and reduced vision canoccur and may be intolerable for some

  4. Reversability?????!!!! Reversability of these procedures has not been shown to date. Therefore, surgeons must take utmost care in patient selection to make sure that the procedure does not cause permanent harm

  5. Publication 1

  6. Publication 2

  7. PharmacologicalCorrection ofPresbyopia

  8. Accommodation • Ciliary muscle contraction (modifying the shape and the position of the crystalline lens) • Miosis • Convergence

  9. Pharmacological Correction * Parasympathomimetics: Stimulation of parasympathetic innervation (accomodation) and * Non-steroidal anti-inflammatories (NSAID): Prolonging the effect of the parasympathomimetic action * Artificialtearsubstituteprolonging action and preventingdryness

  10. Resulting in

  11. IncreasedDepth of Focus

  12. More on DoF • Increasing the DOF is advantageous in some circumstances. The age-related reduction in amplitude of accommodation that causes presbyopia can be ameliorated by increasing DOF. • Depth of focus is most strongly affected by the pupil size--- when the pupil is very constricted, the depth of focus is large, and when the pupil is dilated, it is narrow.

  13. Decrease ofHigher Order Aberrations

  14. More on HOA Studies show that less higher-order aberrations in the eye result in better quality of vision. In the laboratory, Pablo Artal, Ph.D., showed eliminating all higher-order aberrations produces the best visual performance. In addition, studies from Steve Schallhorn, M.D., global medical director of Optical Express, with 140 pilots and 228 clinic patients showed that the best visual performance occurred with the lowest amount of higher- order aberrations.

  15. HOA There are numerous higher-order aberrations, of which only spherical aberration, coma and trefoil are of clinical interest. Doubling pupil diameter increases spherical aberration 16 times. Thus, a small change in pupil size can cause a significant change in refraction.

  16. Results n=81

  17. Exclusion Criteria • Myopia or Astigmatism > 1.0 diopters • Hyperopia > 1,0 diopters • Corneal, Lens and Vitreous opacities • A question mark for lens opacities (cataracts) • Retinal pathologies • Chronic general pathologies

  18. Age & Gender • Number of eyes: 81 • 48 femaleeyes • 33 maleeyes • Age ranging from 42 to 74 years of with a mean of 52 years.

  19. Ophthalmological Status • 2 eyes with toriciol • 8 eyes with spherical iol • 4 eyes with cataract • 10 eyes post LASIK and PRK • 57 presbyopiceyes

  20. Refraction • Sphericalrefractionranging from +1,50D to - 0,75D • Astigmatism ranging from Plano to -1,75 D.C.

  21. All the eyes received 1-2 dropsPatients with dark iris received as a rule 2 drops

  22. Pupil Reaction

  23. UCVA Distance 0.932

  24. UCVA Near 0.649 0.356

  25. Depth of Focus 2.596 1.656

  26. Adverse Reactions • 4 eyes with nausea just after instillation and very quickly relieved. • 2 eyes with dryness that gradually disappeared • 2 eyes with burning feeling that gradually disappeared • 4 eyes with stinging feeling that gradually disappeared • 4 eyes with headache that gradually disappeared • 4 eyes with blurry dist. vision that gradually disappeared • 0 reaction 61 eyes

  27. Post LASIK Post Cataract N=24

  28. IOL & R.S. improvement

  29. Conclusions • Topic treatment to correct presbyopia is a safe and easy way to eliminate the use of glasses in presbyopic patients. But a complete and careful examination of each patient is necessary and you have to know that it is not suitable for all presbyopic patients. • On average, a 1mm reduction of pupil size was associated with a 0,9D increase in depth of focus. • Complete reversability – no use of drops means no improvement of UCVA for distance or near

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