Algorithmic Approach Using Lens Biophysics And Accommodation To Choose An Appropriate Procedure For Pre Presbyopia Correction

Presbyopia is a common error resulting due to reduced amplitude of accommodation in the later part of life. A reduced amplitude is also associated with a reduced depth of focus. These patients need thorough evaluation with special detail to lens densitometry for lens changes, evaluation of binocular single vision anomalies and aberrations in order to achieve optimum post operative visual outcomes and achieve spectacle independence. The purpose of this study is to to devise a simplified algorithm to choose an appropriate procedure for pre presbyopia correction using lens based parameters and accommodative ability

Narayana Nethralaya Superspeciality Eye Hospital , Bengaluru , India

60 eyes of 30 patients, age group between 35-40 years underwent routine preoperative examination with imaging on Pentacam HR for lens densitometry, iTrace aberrometry for dysfunctional lens index (DLI) & assessment for Non strabismic binocular single vision anomalies (NSBVA). Those with good DLI, normal lens densitometry and normal orthoptic evaluation were further evaluated by measuring dynamic accommodation using Osiris T (CSO, Italia) Patients who had good accommodation, normal DLI, normal orthoptic evaluation & those suitable for refractive surgery underwent laser vision correction. Those who had poor accommodation and NSBVA were treated accordingly, reassessed at 3 months and those who showed improvement in the NSBVA underwent surgery.

44 eyes with normal DLI, good dynamic accommodation and normal lens densitometry underwent laser vision correction. 12 eyes with poor dynamic accommodation had convergence insufficiency and were treated with home and office based exercises. 4 eyes with poor DLI and poor accommodation were treated by lens based procedure with clear corneal phacoemulsification procedure with an extended depth of focus IOL implantation.

A new simplified algorithm for choosing an appropriate procedure for pre presbyopes based upon dynamic accommodation, dysfunctional lens index, lens densitometry and non strabismic binocular single vision assessment may aid in achieving better postoperative visual outcomes and hence improved patient satisfaction.