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Scleral approaches to presbyopia: past and future

Poster Details

First Author: M.Jackson USA

Co Author(s):    A. Hipsley   B. Hall                 

Abstract Details

Purpose:

To present the historical scleral techniques that attempted to address the loss of accommodation in presbyopia along with the mechanisms of action and surgical technique. To further present the progress in scleral techniques, technologies, and results.

Setting:

Literature review.

Methods:

A literature review was conducted of the historical scleral approaches to presbyopia and their clinical findings. Specific reference is made to the future of the scleral surgical space for treating presbyopia.

Results:

Scleral surgical procedures seek to restore effective range of near and intermediate vision through both true accommodation and pseudoaccommodation. The most important advantage over other more invasive options to treat presbyopia is the ability to treat presbyopia without touching the optical axis of the eye. The early scleral techniques did not meet adequate standards for efficacy and safety and were still extremely invasive. One next-generation scleral technology has demonstrated objective increases in accommodation averaging 1.25 D to 1.50 D, including 0.25 D in true accommodation, with no change in the optical and geometric properties of the eye.

Conclusions:

The issues of visual disturbances or reduced best-corrected acuity that are associated with multifocal and aspheric approaches limit their appeal. Corneal inlays and onlays still require cutting of the cornea and extending depth of focus still comes with some compromises. An effective scleral solution that increased both dynamic accommodation and expands depth of focus without compromise or altering the optical and geometric properties of the eye would appear both desirable and achievable.

Financial Disclosure:

gains financially from product or procedure presented, receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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