The simple fact is, we are all marching toward presbyopia. It is the only eye dysfunction with 100 percent penetration.
The treatment market for presbyopia and myopia is set to surpass $28 billion by 2026, according to the latest Grand View Research, Inc. report. So, while we are all destined to face presbyopia at one point or another, advances in treatment options are expanding.
This was the message from Larry Baitch, OD, PhD, FAAO, of the Massachusetts College of Pharmacy and Health Sciences (MCPHS) College of Optometry, at the American Academy of Optometry 2019 annual meeting in Orlando.
Overview of presbyopia management
Presbyopia is a significant concern in optometry, marked by a loss in dynamic accommodation. Though we still don’t fully understand the relationship between presbyopia and accommodation, research is giving optometrists some insights into how to manage presbyopic symptoms through surgical intervention and medical therapies.
“What we’re seeing is that the eye is actually an adaptive optic,” Dr. Baitch says.
Though there are multiple theories on the exact mechanisms behind accommodation, it is known that restoring lenticular dynamic accommodation is a crucial goal for improving near vision in presbyopia management.
New surgical modalities
Several surgical treatment tools in the pipeline may offer better outcomes for presbyopic correction. Dr. Baitch says that the Crystalens intraocular lens (IOL, Bausch + Lomb) was a forerunner for many of these technologies.
This lens was key to the US Food and Drug Administration (FDA) guidance that any device labeled as an “accommodative device” must provide at least one diopter of accommodation documented by objective and subjective means over long-term studies.
SightLife Surgical Kamra
The only FDA-approved corneal implant available today is the Kamra (SightLife Surgical).The pinhole-aperture implant has experienced high levels of patient satisfaction due to improved, uncorrected near visual acuity, Dr. Baitch says. However, it is not a magic-bullet solution as retrospective studies have shown explantation rates of 5.7 percent over 31 months.
Though adverse events are unavoidable for surgical procedures, eyecare providers need to balance the risks against the benefits for each patient.
“You have to decide whether that is acceptable to you,” Dr. Baitch says.
Presbyopic allogenic refractive lenticule (PEARL)
The PEARL technique uses a femtosecond laser to create a lenticle in the corneal stroma, with the goal of using the patient’s tissue for the presbyopic inlay.
This approach reduces complications of synthetic material rejection and supports better oxygen and nutrient flow through the cornea. However, a primary drawback is that it’s still a modified monovision technique.
“Again, it’s still a multifocal,” he says.