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PubMed1984

Eye changes after forty.

The most common "physiologic" change that occurs in the eyes after age 40 is loss of elasticity of the lens, resulting in presbyopia. Xanthelasmas commonly occur at this age and should be removed only for cosmetic reasons. Entropion and ectropion can be quite irritating; both results from laxity of the eyelid tissues. Relaxation of eyelid tissues also contributes to blepharochalasis. Glaucoma and formation of cataracts are not normal changes but do appear with increasing frequency in persons over 40.

Adult↗
PubMed1980

Management of the exceptional presbyope.

Presbyopia, like many age related conditions, does not present an identical picture in all patients. Most, but not all, presbyopes can be cared for satisfactorily by the use of conventional optometric corrections. Some atypical presbyopic patients, however, may benefit from the unorthodox remedial procedures mentioned in this paper.

Age Factors↗
PubMedDate not supplied

Accommodation of an endocapsular silicone lens (Phaco-Ersatz) in the aging rhesus monkey.

BACKGROUND: After accommodative changes of endocapsular silicone lenses in presenile nonhuman primates had been confirmed by several authors, this pilot study was designed to evaluate the ability of an artificial lens to restore accommodation in the senile eye of a rhesus monkey that had previously lost most of its accommodative capability. METHODS: An injectable silicone lens was implanted in one eye of six rhesus monkeys who were older than 17 years. Accommodation was documented as the amount of decrease of anterior chamber depth after pilocarpine stimulation. RESULTS: Four months after surgery, the decrease of anterior chamber depth was higher in the operated eye with the silicone intraocular lens in the two monkeys who had marked presbyopic changes in the natural lens. One monkey was kept for more than 4 years, retaining a decrease of at least 0.5 mm with the silicone lens, whereas the natural lens failed to show any accommodative change. CONCLUSIONS: These findings support recent reports that presbyopia is primarily a consequence of lenticular aging rather than ciliary muscle factors. A pliable injected lens may therefore have the potential to restore accommodation in the senile primate eye.

Accommodation, Ocular↗
PubMed1995

The presbyopic add. II. Age-related trend and a gender difference.

New transverse clinical data are presented which confirm and extend earlier results to be found in the literature describing the time course of presbyopia-as indicated by the magnitude of the binocular spectacle add--in normally sighted male and and female Caucasian subjects. An initial steep increase in add requirement beginning in the early forties becomes relatively slower but still of significance beyond the mid-fifties. This observation is correlated with the age-related progressive decline in the amplitude of accommodation, itself a consequence of physiological changes in the crystalline lens and capsule. The continuing need for an increase, albeit at a reduced rate, in the positive near supplement beyond the mid-to-late fifties-by which time little or no useful accommodation is available-is now attributed to the visually disruptive effects within the high spatial frequency domain of progressive age-related lenticular changes. The magnification afforded by the positive add increases spatial grain and thereby enhances visibility of detail in an ageing visual system free of any gross senile visual pathology. A small but consistent gender difference is revealed in presbyopic corrections: physiological and physical bases are suggested for the observation that females require an add of greater magnitude than their age-matched male counterparts.

Adult↗
PubMedDate not supplied

[State of accommodation depending on age of emmetropic and hypermetropic subjects engaged in diamond sorting].

Accommodation was studied in 449 diamond sorters aged 17 to 51 engaged in this work for 1 to 34 years with emmetropic and hypermetropic refraction. Questionnaires helped detect subjects who had no complaints of vision (group A) and those with asthenopia complaints (group B). In both groups, in emmetropic and hypermetropic subjects, the furthest point of clear vision was converging the eye by 1.96 +/- 0.04 diopters on an average, that is, there was pseudomyopia. In hypermetropic subjects with occupational ophthalmopathy the nearest point is withdrawn starting from the age of 31-35 till it merges with the furthest point in subjects over 45, that is, the accommodation volume becomes nearly nuel. The results of this study contradict the assumption existing in ophthalmology about an earlier onset of presbyopia in hypermetropia than in other types of refraction. Early correction of near vision is connected with superimposition of accommodation deterioration in ametropia. It is recommended to carry out rehabilitative measure as soon as the first asthenopia signs manifest; these measures should be aimed at weakening of refraction by the site of the furthest clear vision point. In subjects aged 31-35 with occupational ophthalmopathy refraction by the nearest clear vision point should be enhanced if possible.

Accommodation, Ocular↗
PubMed1995

Accommodation-convergence relationships and age.

PURPOSE: The objective of this study was to determine if there are differences in accommodative-convergence/accommodation (AC/A) and convergence-accommodation/convergence (CA/C) ratios in subjects with increasing age. The authors aimed to relate the findings to the present theories of the development of presbyopia. METHODS: Using a Canon AutoRef R-1 to measure accommodation and an IRIS eye movement monitor to measure eye movements, the authors determined objective AC/A and CA/C ratios for 23 subjects between 17 and 42 years of age with normal binocular vision. Changes in accommodation and convergence responses were stimulated by lenses (-1.00 DS and -2.00 DS) and prisms (4 and 8 prism diopters), respectively. Measures were made at two visits on consecutive days. RESULTS: A moderate linear relationship was found between AC/A ratio and age (P < .002), and a strong linear relationship was found between CA/C ratio and age (P < .0001). The decrease in CA/C ratio with age was due to a decreased accommodative response to prisms (P = .0001). Measurements were reliable, with 95% confidence intervals at +/- 1.28 delta/D and +/- 0.02 D/delta for AC/A and CA/C ratios, respectively. A reciprocal relationship existed between the AC/A and CA/C ratios. CONCLUSION: The AC/A ratio increases, and the CA/C ratio decreases, in persons between 20 and 40 years of age. This may be because increasing ciliary muscle contraction is required to produce a given change in accommodation with increasing age or because of changes in the adaptability of the tonic accommodation and vergence systems with age.

Accommodation, Ocular↗
PubMed1993

[Presbytia: are eyeglasses unavoidable?].

The power of eye accommodation to close vision decreases with age. This physiological process, called presbytia (or presbyopia), occurs in all people reaching maturity, irrespective of sex and race. This paper describes the evolution of our knowledge concerning this phenomenon and the various means of correction utilized nowadays to compensate for the loss of accommodation power.

Adaptation, Ocular↗
PubMed1996

[Ultrasound biomicroscopy imaging of accommodative configuration changes in the presbyopic ciliary body].

Direct observation of the position of the ciliary body was possible only in cases of gross anatomic, and probably also functional, abnormalities. Utilizing the 50 MHz ultrasound biomicroscope, we investigated the profile changes of the ciliary body in ten eyes of ten patients, ranging in age from 54 to 86 years while they were ocusing on a target at a distance and afterwards on an object up close. After electronic image processing of ten single video pictures from each accommodative status, a summarized picture for every accommodative status was obtained. In seven of ten cases, during accommodation a remarkable shift of the ciliary body was observed anterior to the iris and in the direction of the lens equatore, while the iridociliary body contact zone became wider in five of the ten eyes. Ultrasound biomicroscopy allows visualization of the dynamics of the accommodative process. As the human ciliary body does not lose its contractility in the senium, the loss of accommodation in presbyopia is mainly caused by age-related changes of the lens and capsula.

Accommodation, Ocular↗
PubMed1995

[An image of Saint Ottilia with reading stones].

Reading stones to facilitate reading in cases of presbyopia are mentioned in the literature, for example in the works of the Middle High German poet Albrecht and of Konrad of Würzburg. Most representations of the abbess, Saint Ottilia, show her holding a book with a pair of eyes in her hands. A gothic altarpiece (1485-1490), kept in the museum of the Premonstratensian Canons of Wilten in Innsbruck, Tyrol, shows a triune representation of St. Anne, the mother of the Virgin, with Mary and Jesus and St. Ursula with her companions. St. Ottilia is depicted on the edge of the painting. Two lenses, one on either side of the open book in her hand, magnify the letters underneath. As the two lenses are not held together by bows or similar devices, they are probably a rare representation of reading stones. The alter showing scenes of the life of St. Mary and St. Ursula was done by Ludwig Konraiter. A panel on the same alter, depicting the death of the Virgin, shows an apostle with rivet spectacles.

Austria↗
PubMed1996

Clinical assessment of Holo-Or trifocal diffractive contact lens.

PURPOSE: To evaluate the objective and subjective performance of the Holo-Or multifocal contact lens, a new rigid gas permeable (RGP) trifocal diffractive contact lens. METHODS: Eleven experienced and two non-experienced RGP contact lens wearers participated in the study. Eleven patients were presbyopic (age range: 40-57 years) and two were aphakic (ages: 12 and 14 years). Each patient was evaluated by comparing best spectacle correction to Holo-Or multifocal contact lens correction, using the following tests of visual function: visual acuity at 6 m, 80 cm, and 40 cm; contrast sensitivity at near and distance; and depth of focus. RESULTS: No significant differences were found between best spectacle correction and the Holo-Or contact lenses. When using the contact lenses, there was an improvement in depth of focus and a small reduction in contrast sensitivity compared with best spectacle correction. Overall satisfaction and comfort was good to excellent in ten of thirteen patients. CONCLUSIONS: Holo-Or trifocal diffractive contact lenses are a satisfactory means of optical correction for patients with presbyopia or accommodative problems.

Adult↗
PubMed1996

[Selected problems with ocular accommodation in children and youth].

This paper intends to present some accommodative disturbances which cause difficulties in reading and should be differentiated from dyslexia. The work describes the way of evaluation of accommodative convergence to accommodation rate (AC/A ratio). Clinical forms of two types of nonrefractive accommodative convergence excess connected with high AC/A ratio, namely hyperkinetic and hypoaccommodative, are presented. In hyperkinetic type, disturbances of ocular movements coordination during reading prevail. Patients with hypoaccommodation disorders suffer from youth presbyopia. The paper describes the ways of treatment of these disorders.

Accommodation, Ocular↗
PubMed1997

[The correction of pseudophakia].

Correction of the pseudophakic patient must consider the possibility of anisometropia with aniseikonia as a consequence. Particular attention has to be brought with young unilateral pseudophakic patient without presbyopia.

Age Factors↗
PubMed1997

[The advantages and disadvantages of bifocal lenses].

The bifocal glasses present three main disadvantages: the jump of the image when the visual axis passes from the far vision glass to the reading segment, the prismatic effect on the near vision point that entails an apparent displacement of the fixed object as well as a degradation of the quality of its image, and the absence of intermediate vision in total presbyopia. Bifocals however keep their indications, even after the availability of the progressive glasses, by people accustomed with this kind of correction, and by others who are not supporting deformations in the lateral vision of the progressive glasses. Suggestions are made for choosing the model of bifocal which is the most appropriate in function of the different situations.

Accommodation, Ocular↗
PubMed1997

[Progressive lenses, history and comfort factors].

Since some fifteen years, progressive glasses tend to replace gradually the bifocal ones as first choice of the correction of presbyopia. This tendency varies however according to continents and countries. The idea of the progressive glass returns mainly to a French (Maitenaz) working in 1956 for the firm Essilor. At that time, large reticences had been emitted by the other firms manufacturing glasses, that do not suspect the success that would have later this kind of correction once imperfections of the infancy will have been solved. Progressive glasses have been improved by taking account of remarks of wearers and by privileging the comfort in the current life, ending to glasses well supported by most of the presbyopes.

Equipment Design↗
PubMed1988

Age-related loss of morphologic responses to pilocarpine in rhesus monkey ciliary muscle.

Ciliary muscle topography and connective tissue distribution were studied by light microscopy in atropinized, pilocarpinized, or untreated eyes from rhesus monkeys of various ages. With age, the connective tissue ground plate between ciliary muscle and ciliary processes thickens, while there is very little increase in connective tissue within the ciliary muscle. With age, the atropinized muscle becomes shorter and smaller in area while it remains unchanged in width and position. In pilocarpinized eyes, the ciliary muscle is shorter, narrower, smaller in longitudinal and total area (ie, more circular and compact), and positioned more anteriorly than in contralateral atropinized eyes. These contractile responses to pilocarpine diminish with age at a rate similar to that for accommodative decline. According to these topographic findings, physicians seeking the pathophysiologic characteristics of presbyopia, which occurs in humans and rhesus monkeys on a comparable relative time scale, should redirect their attention toward the ciliary muscle.

Administration, Topical↗
PubMed1995

Management of diplopia limited to down gaze.

OBJECTIVE: To evaluate the usefulness of various optical and surgical treatment modalities in the treatment of patients who were symptom free in the primary position of gaze yet had symptomatic diplopia in the reading position (down gaze at near). PATIENTS AND METHODS: A retrospective chart review was conducted to identify all patients with presbyopia I have treated who were symptom free in the primary position but had diplopia in down gaze associated with vertically incomitant strabismus. Of 51 patients identified, 32 were symptomatic in down gaze due to a hypertropia associated with a unilateral inferior rectus muscle underaction. Twenty-two of these patients had previously undergone recession of the affected inferior rectus muscle for treatment of thyroid eye disease; four patients, for correction of entrapment secondary to blow-out orbital fracture; and four patients, for treatment of superior oblique muscle palsy. Two patients had undergone prior surgery for superior oblique myokymia. Eight patients had horizontal diplopia associated with an A pattern, and eight patients had horizontal diplopia associated with a V pattern. Three patients had vertical and horizontal diplopia after partial recovery from third-nerve palsy. RESULTS: The treatment modalities were varied and individualized. Treatment consisted of optical management (20 patients), surgical management (21 patients), or a combination of both (10 patients). These treatment modalities resulted in comfortable single binocular vision for reading in 41 of the 51 patients. Successful optical treatment consisted of Fresnel prisms (four patients), slab-off prisms (two patients), single-vision readers (seven patients), switch to nonprogressive bifocal lenses (three patients), and a high bifocal segment (16 patients). Successful surgical modalities included posterior fixation of the contralateral inferior rectus muscle (10 patients), surgery for A- or V- pattern strabismus (five patients), or bilateral inferior rectus muscle recession (six patients). CONCLUSION: Diplopia in the reading position frequently can be alleviated with a systematic approach that includes both optical and surgical modalities.

Adult↗