KHAN AWAR

M AD E SH
S S A S P
U CM
: ABD R Y P
BY M E T
PTO
ER O
TUR
CONTENTS
1. Introduction
2. Epidemiology
3. Signs and symptoms
4. Etiology
5. Classification
6. Management
 INTRODUCTION.
• The word presbyopia comes from the Greek word
presbyos , meaning "old man" or "elder", and the
Neolatin suffix -opia, meaning "sightedness",

• Presbyopia is physiological insufficiency of

accomodation with age.

OR

• The decline in the amplitude of accomodation

expected with age is called as Presbyopia.
 Amplitude of accomodation
with age:
• According to FC DONDERS the amplitude of accomodation chart

AGE AMPLITUDE
• 10 10.6 _13.5
• 15 10.1 _ 12.5
• 20 9.5 _11.5
• 30 6.6 _ 8.9
• 40 4.4 _ 5.9
• 50 1.6 _ 2.0
• 60 0.7 _1.0

The amplitude of accommodation is often measured in diopters (D) and is

typically greater in younger individuals, gradually decreasing with age.
Presbyopia is a common age-related condition where the amplitude of
accommodation diminishes, making it more challenging for individuals to focus
on close objects.
Relation b/w Amplitude of Acc. & Age
Epidemiology of presbyopia

In 2005 the worldwide rate was 1.04 Billion.

In 2020 the worldwide prevelence is accepted to rise to

1.37 Billion.
The average age of those with first reporting
symptoms of presbyopia is between 42 and 44 years of
age
Signs And Symptoms:
 Blurred near vision at early 40.
 Large customary working distance.
 Delays in focusing at near and
distance.
 Asthenopic symptoms like headache
drowsiness and fatigue of cilliary
muscles.
 Intermittent diplopia due to associated
disturbance of convergence.
 Etiology:
 The main causes of presbyopia are:

 Modulus of elasticity(deformation)
of lens capsule(springiness)
 Modulus of elasticity(deformation)
of lens substance.
 Loss of elasticity of ciliary muscle.
The mechanics of Accommodation in
Presbyopia

• Two views are currently in conflict,

–The view of Donders (1864) that
presbyopia is caused by a decrease in the
force of contraction of the ciliary muscle
with age, and
–The opposing view of Helmholtz (1855)
that the lens becomes more difficult to
deform with age due to lenticular
sclerosis.
Continue….
• At present we know that, in fact, the ciliary
muscle undergoes a compensatory
hypertrophy as accommodative amplitude
decreases with age.
Sclerosis of lens fibers
• Main cause of presbyopia is sclerosis of the
fibers of the crystalline lens and changes in its
capsule, which reduce the spontaneous
steepening of its surfaces when ciliary muscle
contracts.
• Because these changes result in inadequate
adjustment of the lens for various distances,
objects that are close will appear blurry.
Deficiency of Ciliary muscle
• The other cause may be that the ciliary
muscle itself becomes less efficient with
advancing age.
• Loss of ciliary muscle power and loss of
elasticity of the zonules, that connect the
ciliary muscle to the lens, are not major
causes but are believed to contribute to
the problem.
Classification of presbyopia:
• Borderline beginning of early presbyopia.
INCIPENT • Complain of near vision difficulty but rejects the
add.

• Patient demand of near add because of severe

FUNCTIONAL symptoms.

• Progression of functional presbyopia into

ABSOLUTE: absolute with complete loss of accomodation.

• :decrease in amplitude of accomodation in dim

NOCTARNAL light increase pupil size and decrease depth of
field.

• accomodative ability is insufficient for near task

PREMATURE: main reason may be uncorrected hypermetropia
Risk factors:

 Age.(40 and above)

 Hyperopia.( add. Accomodation
demand)
 Occupation.
 Gender.(early onset in female)
 Ocular diseases. Removal or damage to lens, zonules or
ciliary muscle
 Systemic diseases.(DM, MS, Anemia)
 Drugs.( antidepressant, Antihistamines, Diuretics )
 Geographic factors.( UV exposure)
Management:
Plus spectacle correction
Bifocal lenses
Trifocal lenses
Progressive addition lenses
Contact lens
Spectacles:
Bifocal Contact lens:
Some methods of correction:
• Some methods of correcting presbyopia:
1. Age base method.
2. Plus add method.
3. Duochrome test.
4. Near point of accomodation.
5. Bells retinoscopy.
 Age base method:
In this method the correction is prescribed as:
 AGE CORRECTION
 40y 1.00 DS
 43y 1.25 DS
 45y 1.50 DS
 48y 1.75 DS
 50y 2.00 DS
 55y 2.25 DS
 60y 2.50 DS
Plus build up method:
 Most simpler method of prescribing near add.
 0.25 DS is gradually added to the trial frame until
the required addition is gained.