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    Managing presbyopia with surgery

    Las Vegas—Addressing presbyopia through surgery is no easy task, as optometric practitioners know. It’s hard to correct presbyopic refractive errors without sacrificing vision in other areas.

    But demand for more advanced treatment options for presbyopia is increasing, says Bill Tullo, OD, FAAO, Optometry Times Editorial Advisory Board member at Vision West Expo 2016. He and Jim Owen, OD, FAAO, discussed the current methodologies for surgically addressing presbyopia and new technologies that are shaping the process.

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    Current methods

    Current strategies for vision correction of presbyopia are still somewhat limited—most surgical methods involve monovision, intraocular lens (IOL) implants, ablative therapies, or corneal inlays. Monovision correction has been the standby for years and has been the cause of much frustration from patients unwilling to lose their near vision for the sake of distance correction. Early IOL options also suffered drawbacks from their close focal points that made moderate vision difficult.

    The bottom line is that there is no easy answer for how to correct presbyopia without compromising vision in another area. Fortunately, new technologies and strategies are being developed that may change the way optometrists—and their patients—consider presbyopia.

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    Bilateral surgery

    Among the emerging trends in refractive correction is the push toward bilateral surgery.

    “For the most part cataract surgery in the U.S. is still done one eye at a time,” says Dr. Tullo. “And because of that, you have this decision point after the first lens is put in; what do you do with the second eye?”

    He said that his own patients did better when both eyes were corrected at the same time, and Dr. Owen agrees.

    “Patients tolerate it much better,” Dr. Owen says.

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    Bilateral surgery has been avoided in the U.S. . due to cost and legal barriers, but Dr. Tullo predicts that the profession will see an increase in bilateral surgery in the near future.

    “Most people think there’s going to be a dramatic shift toward bilateral cataract surgery in the next five years simply because of cost,” Dr. Tullo says. “You just can’t afford to keep doing it one eye at a time…cost is going to override the litigation concerns.”

    This reduction in cost and improved convenience may open the doors for more patients considering surgery, more demand for effective treatment options, and better refractive outcomes down the line.

    Cataracts and refractive IOLs

    Cataract surgery is one of the most common optical surgeries performed, and cataracts affects patients as they age. This mirrors the progression of presbyopia, which can continue developing until around age 65. Joint treatment of cataracts and presbyopia is emerging goal for both patients and practitioners alike.

    Related: The pros and cons of clear lens exchange

    “Cataract surgery has become refractive surgery,” says Dr. Tullo, “and the patients having cataract surgery are a lot younger, and many of them have had refractive surgery. So, their expectations for cataract surgery are no different than they are for LASIK or PRK.”


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