Presbyopia surgical treatments: How do we remove progressive glasses?

This blog on ‘Presbyopia surgical treatments: How do we remove progressive glasses?’ has been contributed Dr. Miguel Morcillo, Consultant Ophthalmologist, Specialist in Cornea and Refractive Surgery.

What is Presbyopia?

When you have difficulty in focusing on near objects, usually as we head into our 40s & 50s, you probably are developing presbyopia. It is a condition that affects everyone as they get older. Why presbyopia happens is not clear. When we are young we have a crystalline lens that is very flexible and the muscles within the eye can manipulate it so that it changes its shape, and therefore its power, so we can focus over a range of distances. This is a reflex and is done automatically without thought or effort. As we age, the lens becomes a stiffer, more rigid structure and it becomes harder for the muscles to get the lens to increase in thickness to become more powerful. As such, focusing up close becomes more problematic.

How does Presbyopia occur?

Presbyopia happens gradually. First, people start to put near objects a bit far, or increase the size of the font at the computer. It can work for few years but finally, the need for glasses to perform near activities appears. These glasses are magnifiers that can be used only for near in case the patient has good far vision, or may be added to the far glasses if the uncorrected far vision is not good. Presbyopia has been long time corrected with glasses but for those who don’t want to wear glasses, we have some surgical techniques available to correct this problem.

Treatment options for Presbyopia

Presbyopia surgery is not new. Monovision techniques are long time performed. They can be done either with laser or with intraocular lenses. The aim of monovision is to use the ability of the brain to process both eyes’ individual images to create the image we see. We call it binocularity. One eye is focused in far distance and the other eye is focused in near distance. Depending on the distance we focus, the brain chooses the best image as the principal image and uses the other eye as supporter of the main image. This combination is very useful in most of the daily activities and only in extreme far or small near activities, occasional use of glasses may be required. Monovision works quite well in myopic patients.
For those patients where monovision doesn’t match their expectations, we have multifocal intraocular lenses. These lenses are implanted after removing the natural lens. This is called refractive lens exchange. The multifocal intraocular lenses have different focuses to see in the most used near distances (mobile, books or computer screen) and also for far distances. They can be used in only one or both eyes, depending on the case. They can be implanted in cataract patients as well. Hypermetropic patients are most frequently implanted.
There are also some other techniques as corneal inlays, extended focus lenses or accommodative lenses. They may be used in some other cases but less frequently.
We select the technique depending on the age of the patient, the kind of glasses they are wearing, the current visual performance and the visual requirements. A complete eye check must be done to rule out any other pathology so the best results are obtained in healthy eyes. The results are excellent and most of the patients need no glasses at all. In few cases, it is possible some occasional use of glasses for specific activities. Even in these cases, we can provide high satisfaction levels to our patients and a change in their quality of life, where the continuous use of glasses before the surgery was very annoying for them.

Moorfields Eye Hospital Dubai Links Chronic Stress to Loss of Vision

Ophthalmologists at Moorfields warn that the impact of persistent levels of high stress on vision is often overlooked by physicians.
20 December 2019, Dubai, UAE Specialists at Moorfields Eye Hospital Dubai have called for greater awareness of the link between persistent levels of psychological stress and vision problems.
When individuals feel anxious or scared, the body releases certain stress hormones that can impact the brain and eyes. While many of the symptoms on vision are mild, including blurred vision, dry eyes, and eye twitching, Moorfields experts warn of potentially more serious consequences if stress is allowed to persist, such as central serous retinopathy and hysterical amblyopia, a syndrome that can lead to severe loss of vision.
According to Moorfields Eye Hospital Dubai, the link between stress and visual impairment is often misunderstood, raising the potential of serious conditions that could have been treated at an early stage.
Dr. Miguel Morcillo, Consultant Ophthalmologist, Specialist in Cornea and Refractive Surgery at Moorfields Eye Hospital Dubai, said: “So many of us are exposed to stress in our daily lives to the extent that it is almost considered normal to feel stressed. But the implications on vision can be serious and are frequently overlooked by physicians. While the symptoms of stress are mostly mild, if allowed to persist they can lead to significant problems.
“Ophthalmologists at Moorfields have to rule out any real eye problem, no matter the type of test required. But sometimes chronic and persistent stress is the cause. In certain cases, the patient must be referred to a psychologist or psychiatrist for a mental health approach. We are calling for greater awareness of this issue among members of the public and general physicians.”
When under stress, the body’s natural response is to produce cortisol, which in turn affects the sympathetic nervous system, causing vascular miss-function, vasospasm, brain processing problems or inflammation. As the eye and brain are sensitive to vascular changes, any imbalance can affect their normal function. Adrenaline is also increased during stress, which can lead to increased eye pressure, resulting in blurred vision.
According to ophthalmologists, eye twitching (known as myokimia) is a common complain among highly-stressed patients. These involuntary contractions of muscular fibres around the eye are intermittent throughout the day and usually disappear after few days.
Chronic stress may also cause dry eyes. Stress hormones increase blood flow in body areas such as muscles and the heart. As a result, the production of tears is limited and dry eye symptoms may appear, especially if the patient is exposed to screens for an extended period of time.
Dr. Ammar Safar, Consultant Vitreoretinal surgeon and Medical Director of Moorfields Eye Hospitals in the UAE said: Central serous retinopathy or CSR is a condition that affects younger individuals who are under high levels of stress and results in blurring and distortion of the central vision due to accumulation of fluid under the central retina. This is common in young professionals undergoing very stressful periods and luckily resolves on its own in most people.
In extreme cases, hysterical amblyopia may appear, which can result in severe loss of vision, particularly decreased near and distance vision, reduced binocular vision and a mild hypermetropic shift. In these cases vision is not improved with the use of corrective lenses.
When chronic stress leads to a psychological conflict, physical symptoms commonly appear, including low vision or restricted visual field in one or both eyes. Moorfields advises that such patients seek a complete visual exploration, including various tests to rule out physical conditions, in addition to psychiatric treatment.