EyeWorld India December 2021 Issue

REFRACTIVE 20 EWAP DECEMBER 2021 Contact information Bafna: drbafna@clevelandeyeclinic.com Waring: gwaring@waringvision.com T he large number of patients worldwide with presbyopia creates a unique opportunity for eyecare providers to improve patients’ quality of life, according to George Waring IV, MD, FACS. There are more than 2.1 billion presbyopes worldwide. Dr. Waring noted the many implications of this large Presbyopia treatment options now and on the horizon by Ellen Stodola Editorial Co-Director number, not just from a quality of life standpoint but also in terms of economic burden related to falls. Many falls are related to bifocal glasses, Dr. Waring said, which most people with presbyopia require at some point in their life. “Our discussions and surgical decision making regarding presbyopia are framed in terms of dysfunctional lens syndrome,” which Dr. Waring said is a characterization of the aging process of the internal crystalline lens. Stage 1 is presbyopia; stage 2 is presbyopia and early lens opacity; and stage 3 is a cataract affecting daily activities adversely. “We have proposed an algorithm for the treatment of presbyopia based on age, refractive status, and lens opacity,” he said. 1,2 Dr. Waring said treatment options are largely dictated by patients’ refractive status, meaning if they’re hyperopic and the higher the degree of hyperopia, the earlier a lens- based intervention procedure may be recommended. “The more myopic they are, we may have a higher threshold to do a lens-based procedure, maybe even a lens replacement procedure, and a lower threshold for a cornea- based procedure or implantable contact lens,” he said. For the plano presbyope, Dr. Waring said they are moving toward a lens-based procedure to maintain binocularity, which he thinks improves vision performance and may lead to higher patient satisfaction. “When considering age, once pharmacologic therapies are approved for the treatment of presbyopia, we may This article originally appeared in the September 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Dr. Waring implants a hybrid diffractive extended depth of focus and multifocal toric IOL during a refractive lens exchange. Source: George Waring IV, MD, FACS