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Quality of vision and subjective satisfaction in new non-spectacle systems for restoring accommodation in presbyopic people

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Non-spectacles approaches can be a suitable option for presbyopia correction

Currently, there are over one billion individuals over the age of 45 suffering from presbyopia. The increasing demand for non-spectacle correction of presbyopia necessitates research into alternative more permanent solutions.

Fundamental Research

Presbyopia is the physiological, age-related loss in near visual function associated with reduction in accommodation. Traditionally corrected with spectacles, the number of presbyopia sufferers globally is expected to increase given the rise in the ageing population. In the search for alternative presbyopia correction approaches, the EU-funded PROVISIONE project employed new innovative optical systems for ocular restoration in presbyopia. The project involved a series of prospective and retrospective clinical studies that were carried out on presbyopic patients in participating clinical centres. Researchers evaluated the relative efficacy of two non-spectacle optical systems – scleral implant surgery and monovision induced with contact lenses (CLs). They also compared them to other available systems such as multifocal CL and intraocular lenses. Bilateral scleral implants were assessed in a group of 20 patients (range 53-63 years) while the relationship between monovision and eye movements was explored in a group of 15 naïve presbyopes (48.9 ± 3.1). Furthermore, research to study the brain-evoked response in 14 presbyopes (49.5 ± 3.2 years) while monovision correction was carried out. Insight into the mechanism (optical, physiological, perceptual) underlying the two non-spectacle optical systems was generated. Contrast sensitivity and visual acuities data were collected in over 334 healthy subjects from 6 to 88 years, which served as normative data for comparison purposes. Through a validated questionnaire, clinicians were able to measure subjective perception of visual near function and assess the relative subjective benefits of different presbyopic corrections in 207 subjects (mean age 56.3 ± 9.7 years). A new procedure to assess multifocal CL centration by a computerised topography-based system has been developed which has resulted in accurate and reliable (inter- and intra-observer) results. The PROVISIONE team expect to impact the assessment of multifocal CL, further improving the quality of correction in presbyopic patients. Overall, results showed that monovision rather than scleral implant surgery was more effective in restoring accommodation in presbyopia sufferers. This was evident through subjective satisfaction remarks as well as vision functionality. Therefore, monovision through surgery or CL seems to be a suitable non-spectacle option to correct presbyopia.


Presbyopia, PROVISIONE, scleral implant surgery, monovision, contact lens

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