Clinical Strategies For Successful Evaluation Of The Presbyopic Patient

To review subjective versus objective assessments of presbyopia, and compare the utility of a novel aberrometer. 

IRB registered, monitored Pilot experimental single site study, Panama Eye Institute, Panama

Review new clinical strategies for assessing presbyopia with subjective and objective techniques.  Quality through focus vision is defined as a Dynamic Range of Focus(DRoF), including accommodation, pseudoaccommodation, extended depth of focus, pupillary response.DRoF through focus curves of presbyopic subjects were measured using the dynamic Hartman Shack aberrometer ( WaveDyn) before and after Laser Scleral Microporation therapy. Target started hyperopic relative to the subject’s spherical equivalent and stepped progressively in myopic direction in 0.5 or 1 D steps over several minutes. Realtime DRoF changes were recorded.Through Focus curves at near(40cm), intermediate(60cm) and far(1m) of young controls were compared to presbyopic data.

Most traditional methods of presbyopia assessment have been subjective.  A handful of objective measurement devices have been commercially available, but results have been mixed. With the WaveDyn, young presbyopes were able to focus on the target throughout the sequence until they reached their accommodative range and were unable to track the target.  DRoF range was defined as the difference between the refractive starting power and the power where they lost track.  DRoF decreased with age.  Case examples of presbyopes before and after LSM were analyzed. Post LSM presbyopes showed an improvement in DRoF compared to preoperative measurements.

Dynamic wavefront testing gives real time dynamic behavior of the DRoF changes occurring throughout the visual spectrum from near to far and far to near. Dynamic Aberrometer may better address the true response of total through focus quality vision than static testing or subjective measurements.  DRoF is progressively lost  with increasing age, however LSM shows promise for vision recovery in presbyopic patients in all ranges of DRoF.