Zdenek Eye Institute: Presbyopia Treatment

Are your arms becoming too short?

Did your phone book shrink?

Do you ask "What is this I'm eating?", while enjoying a dinner by candlelight?

Are words getting blurry at close up?

Let me guess...

You're over 40, and its not going away!

It's called PRESBYOPIA!!

What is Presbyopia?

The word presbyopia (Prez-bye-OH peeah) is based on a Greek word that means "old eye" and a Latin word meaning "old sight". It is a vision condition that affects the crystalline lens of your eye, causing a progressive loss of the capacity for close accommodation. Accommodation is the ability to focus clearly, at any distance, from normal reading to distant objects. Every adult who reaches an age of 45 years or older will experience Presbyopia. Like wrinkles (gosh darn it!), it is a natural part of the aging process.

How do I know if I have Presbyopia?

As a small child at 10 years of age you were able to focus on small objects or print 2 inches from your eyes. At 30 years of age the same object needed to be placed at least 6 inches away in order to see it clearly. When reaching your mid-40's the focusing range of even 12-16 inches may not be enough. You may have Presbyopia if you find:

There are a couple of theories regarding the cause of Presbyopia. One predominate theory that has existed for over 150 years describes how the crystalline lens (located a few millimeters inside your eye, just behind the iris), of the eye becomes hardened and loses flexibility with aging. It was thought that since skin ages and becomes less elastic, the lens of our eye would do the same. Sometimes referred to as lens sclerosis, this theory was developed by Dr. Helmholtz in 1855 and is still accepted as truth by about 50% of eye care professionals.

In 1994 there was another theory developed by Dr. Ronald Schachar, MD, Ph.D. (of Presby Corp.) that refutes the hardening lens axiom. Thanks to Dr. Schachar's research our understanding of lens accommodation has changed. He tells us that the lens does not lose its flexibility, nor does the ciliary muscle grow weaker with age. Dr. Schachar offers proof that the human lens continues to grow concentrically (similar to the growth of an onion). This growth, in time, begins to crowd the space between the lens and the ciliary muscle. The result is a progressive reduction in the effective function of the ciliary muscle that leads to loss of accommodation.

How is Presbyopia diagnosed? Can it be prevented?

Diagnosis of Presbyopia will begin with a complete eye exam to test the quality of your vision. Using a visual acuity test, your doctor will check for decreased close range acuity. Your doctor may also ask you to describe your condition to see if you have the indicating signs of presbyopia.

Unfortunately, there is no way to prevent presbyopia. It is part of the aging process. By 50 years of age, nearly everyone has some degree of presbyopia that will continue to progress until around 65 years of age. People with farsightedness (hyperopia) often will need help with their close vision early on, while people with nearsightedness (myopia) may find their close vision improves slightly through their 40's, after which time they will also need correction. The effects of presbyopia may be offset by the use of good lighting when doing close work or reading.

Can Presbyopia be treated? The SSP Solution - now in clinical FDA trials!

The treatment for presbyopia may include a prescription for reading glasses, bifocals, trifocals or contact lenses. Because presbyopia could complicate other common vision conditions like nearsightedness, farsightedness and astigmatism, your doctor will perform other tests to determine the specific lenses that would allow you to see clearly. One available alternative is using a monovision contact lens or making a correction on one eye with the use of an Excimer Laser (LASIK). This approach works by correcting one eye primarily for distance vision leaving the other eye for close work, making reading glasses unnecessary. Not everyone can tolerate this approach since it requires an adjustment period but many find monovision correction a satisfactory solution. To see what your choices are, click here to view our Presbyopia Treatment Decision Chart.

There is another surgical alternative called SSP (Surgical Spacing Procedure). Developed by Dr. Ronald Schachar of Presby Corp, this procedure has completed the first phase of FDA Trials. This patented technique involves placing four little pieces of inert plastic (SEB - sclera expansion band) in a circular arrangement in the white part of the eye (specifically the sclera). The SEBs expand the underlying muscle, which can then better manipulate the lens, allowing someone to see at multiple distances, reversing the effects of Presbyopia. Dr. Zdenek is a pioneer surgeon in this revolutionary procedure, having performed SSP on over 70 eyes to date. He has been selected by Presby Corp. to train other surgeons during the FDA trials. If you are interested in participating in the FDA trials, please take a moment to fill out our FDA Study Survey.

A note to fellow Ophthalmologists: If you are interested in training with Dr. Zdenek in this revolutionary new procedure, click here to view our workshop announcement.

Informative Presbyopia Articles from the October 15, 2000 edition of Ocular Surgery News