II. Definitions

  1. Presbyopia
    1. Age-related loss of accommodation

III. Epidemiology

  1. Onset after age 45 to 60 years old

IV. Mechanism

  1. Crystalline lens loses elasticity with normal aging
  2. Accommodation is less effective
    1. Lens no longer thickens on ciliary Muscle Contraction (near Vision, reading distance)

V. Symptoms

  1. Blurred Vision on reading fine print
  2. Eye strain and Headache may occur

VI. Management

  1. Glasses or Contact Lens
    1. Single-Vision reading glasses (inexpensive $20, OTC)
    2. Bifocal glasses (clear far distance and reading distance)
    3. Trifocal glasses (clear far distance, middle distance such as a computer screen, and reading distance)
    4. Multifocal glasses (no-line lenses, with continuous range of correction for various distances)
  2. Monovision
    1. One eye corrected for near Vision
    2. Other eye corrected for distance Vision
  3. Pilocarpine 1.25% (Vuity)
    1. Mechanism: Constricts pupil
    2. Dose: One drop per eye once daily ($80/month)
    3. Onset of action within 15 minutes and duration of 6 hours
    4. Adverse effects include Headache, rare Retinal Detachment risk
    5. Limits night Vision
    6. (2022) presc lett 29(1): 1-2

VII. References

  1. Trobe (2012) Physicians Guide to Eye Care, AAO, San Francisco, p. 146-7

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