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Lecture Four: Accommodation and Presbyopia

The document discusses presbyopia, defining it as the age-related hardening of the lens that reduces accommodation, outlines three categories of presbyopic patients based on age and clinical presentation, and describes methods for determining and refining the near addition prescription to manage presbyopia through positive spherical lenses added to the distance prescription.

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henok biruk
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176 views23 pages

Lecture Four: Accommodation and Presbyopia

The document discusses presbyopia, defining it as the age-related hardening of the lens that reduces accommodation, outlines three categories of presbyopic patients based on age and clinical presentation, and describes methods for determining and refining the near addition prescription to manage presbyopia through positive spherical lenses added to the distance prescription.

Uploaded by

henok biruk
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Lecture Four

ACCOMMODATION AND PRESBYOPIA

Mr. Natnael L.(Lecturer)

April /2017
Objectives
At the end of this session, you will be able
to:
 Define Presbyopia
 Explain the three categories of Presbyopic
patients
 Describe the management options of Presbyopic
patients
Outline
Definition of Presbyopia
Types of Presbyopia
Management Presbyopia
 PRESBYOPIA
Once we have established the correction for
distance vision we can then turn our attention to
near vision
With the distance vision corrected, the patient’s
accommodation is relaxed for distance viewing.
Providing they have adequate amplitude of
accommodation, they can then use their
accommodation to focus at near comfortably
PRESBYOPIA
The decline of amplitude of accommodation with
age is known as Presbyopia
This is due to a hardening of the lens and a
reduction of the elasticity of its capsule.
The main symptom is blurred vision, or difficulty
in sustaining clear vision, at the working distance.
This condition usually occurs when the amplitude
of accommodation has decreased to 4 D
PRESBYOPIA
This condition generally occurs between the
age of 42 and 48 in people living in
European and North American countries
People living in hot climates, such as
Africa, become presbyopic earlier
Types of Presbyopia

1. based on age
Pre-presbyopes

Early presbyopes

Late presbyopes
2. Based on clinical bases
1. Incipient presbyopia
2. Functional presbyopia
3. Premature presbyopia
4. Absolute presbyopia
5. Nocturnal presbyopia
1.Pre-presbyopes
Pre-presbyopes are those who have enough
accommodation to focus at near to their satisfaction
Provided that their ocular motor balance for near is
normal, no extra correction for near vision needs to be
made
You would expect young patient s to have adequate
amplitude of accommodation
If however, you expect there is a problem, measure their
amplitude of accommodation to see if it is normal
Also compare the amplitude of accommodation of the two
eyes, as significant differences between them may indicate
pathology
Reduced amplitude of accommodation
may be associated with:

Latent or inadequately corrected Hypermetropia


Poor health
(Graves’ disease, alcoholism, influenza)
Drug treatment
(asthma, antidepressants) or drug abuse
Hysteria and stress
Reduced amplitude of accommodation
may be associated with:
Ocular disease:
(glaucoma, anterior uveitis, Adie’s pupil)
Neurological problems:
(IIIrd nerve anomalies, or mid-brain lesions)
Myopia:
 Myopes often read without their spectacles and their
accommodation may become feeble through disuse
 They also tend to have larger pupils, which reduces
the depth of focus
Reduced amplitude of accommodation
may be associated with:
Convergence insufficiency
Students (more usually female) around the age
of 12-14
Blurred vision at near

NB: Treatment is aimed at the primary cause, if


possible, and you may need to prescribe a near
addition, even if only temporarily
2. Early Presbyopes
Early presbyopes no longer have sufficient
accommodation to provide adequate near vision
unassisted
The age of onset will vary with the level of visual task
undertaken and with the distance at which the fixation
needs to be undertaken at
Most patients in this group are between 40 – 50, but
some younger patients who have abnormally low
accommodative tonus may also be encountered.
The near addition required by an early presbyope
depends on both the working distance and the
accommodation that the patient still has available
3.Late Presbyopes
Late presbyopes have no accommodation of their own,
so the reading addition is largely determined by the
working distance required
Depth of focus will remain and those with small pupil
diameters may need a lower reading addition than those
with wider pupils.
Unfortunately, the ability to resolve fine detail,
especially in low-contrast situations, may decline with
age and ocular disease.
There may be a need to increase the magnification by
increasing the addition, though this will incur a shorter
working distance and smaller depth of focus
Management Presbyopia
Presbyopia is corrected by positive spherical
lenses on top of the distance prescription
This is called the reading addition or near add
The near addition is always equal in both eyes
Prescribing the Near Addition
A. Begin with a near addition as the starting
point
B. Perform tests to refine this
 

 
A. Methods of prescribing near add:

1. The first step is to measure the patient’s


available binocular amplitude of
accommodation
 Assuming that the patient can use ½ their
accommodation, we use the following
equation: 
 Addition = habitual WD (D) – ½ AA
A. Methods of prescribing near add:

2. Alternatively estimate a near vision addition


based upon:
 The patient’s age

 Habitual working distance

 This is less accurate but quicker

 As a rough guide, the following applies:

 
Cont---
Age Expected near addition
40 – 45 +1.00 to +1.50
45 – 50 +1.50 to +2.00
50 – 55 +2.00 to +2.50
55 upwards +2.50 to +2.75
Aphakes +2.75 to +3.00
 
B. Now refine the addition
Check with + and – sph
Check their range of clear vision
May be impossible to cover all of a patient’s
requirements with one near addition
Additional pairs may be required to cover part of
the range, or multifocal may be required
Note: the reading prescription is the reading
addition added to the distance prescription
 
 
Tips:
1. If the patient currently uses reading spectacles,
refer to the power of them
2. Try not to give too strong a reading addition, if it
is not necessary
3. A presbyope should only need a change in reading
addition every 2 to 5 years and then it should be a
change of +0.50 DS only
4. Remember, although a patient does not read, they
may still need glasses for close work such as
sewing or knitting
The Intermediate correction
 A less powered addition is needed for this longer
working distance
 When we prescribe this Add, we call it the
intermediate Add
 The intermediate Add is approximately half of the
near add
 This is starting point, and then refine
 The intermediate correction can be prescribed as
single vision spectacles, or be incorporated into
bifocal or multifocal spectacles
 
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