Therapeutic Approaches Addressing Loss Of Dynamic Range Of Focus In Presbyopic Patients

To evaluate methods used to restore Dynamic Range of Focus (DRoF) in presbyopes.  Comparison of the mechanism of action, invasiveness, binocularity, and acuity at distance, intermediate and near. 

Asian Eye Institute, Makati City, Philippines 

A literature review was performed to investigate available methods to improve DRoF in presbyopic patients.  Near visual acuity outcomes using miotic drops, corneal inlays and Presbylasik/monovision, diffractive and EDOF IOLs, and LSM were compared.  Visual acuity at distance/intermediate near, true versus pseudoaccommodation, and duration of effect were also compared. 

Greater than 75% of patients achieve 20/40 or better at 40 cm using laser vision correction (LVC), LSM, Diffractive and EDOF IOLS, and miotic drops. Treatment effect of LVC and LSM is sustained over time while miotics is limited to 3 hours.  Distance acuity is significantly reduced below 20/25 in all LVC and Diffractive IOLS but is not significantly affected by miotics or LSM.  Complications including severe adverse events were reported with Smile, supracor/presbylasik, IOL implantation and miotics while LSM has no severe adverse events reported.   

Therapeutic solutions such as miotics and LSM offer minimally invasive options to treat presbyopia disability without changing refractive error. LSM offers recovery of DRoF, unlike corneal procedures and implants, which alter optics to increase near function while sacrificing distance visual quality.