Refractive Correction for Age Related Vision Problems - PowerPoint Presentation

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Refractive Correction for Age Related Vision Problems

Dr. Julian

Tagal

FRCOphth

Ophthalmologist, Sarawak General Hospital

Visiting

Ophthalmologist and LASIK

Surgeon, Borneo

Medical Centre

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Financial Disclosure

NONE

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Aging – It Happens to Everyone

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We can age badly..

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Or we can age gracefully..

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The choice is often up to us..

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We are unable to disrupt aging…

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But what we can do, is learn how to age well…

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And that means, understanding your body..

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It’s very important to take care of your eyesight as you age..

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Social

Relationships

Environment

Emotional Wellbeing

Work

Health

Personal Safety

Financial Wellbeing

Belonging

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So what does refraction have to do with our

quality of life?

Refraction is the process by which the eye focuses light to form clear images

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Contents

1. What is Refraction?

2. Functional Ocular Anatomy and how does it relate to refraction

3. Refractive Disorders

4. Non Surgical Options for Refractive Correction

5. Surgical Options for Refractive Correction

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What is Refraction

First described by Persian

mathematician and physicist, Ibn Sahl

in AD 984 in 'Burning Mirrors and Lenses'

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What is Refraction?

Physics of refraction describe the passage that light takes as it moves between media of different density

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Functional Ocular Anatomy

f

1st Refracting Interface

2

nd

Refracting Interface

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How Does Anatomy Relate to refraction?

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How does Anatomy Relate to Refraction?

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How does Anatomy Relate to Refraction?

The CORNEA and LENS are the refracting surfaces

Help to focus light on to the

RETINA

to produce clear images

The process of ACCOMMODATION allows objects at near distances to remain in focus

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Refractive Disorders

Refractive disorders are disorders of focus

1. Myopia (Short Sightedness)

2. Astigmatism

3. Presbyopia

4. Cataracts

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Refractive Disorders - Myopia

Commonly known as 'short

sightedness’;

Occurs when the CORNEA is too steep; or the EYEBALL is too long

As a consequence, light from distance is focused not on the fovea, but rather in front of it

This results in a blurred image

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Refractive Disorders - Myopia

As a consequence, myopic people are only able to view near items clearly

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Refractive Disorders – Myopia

Most Common Refractive Disorder

In the Asian context, suggested to be highest amongst urban

chinese

, prevalence suggested to be as high as 39% amongst 40-79 year olds

1

Wong TY, Foster PJ,

Hee

J, Ng TP,

Tielsch

JM, Chew SJ

et al

. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest

Ophthalmol

Vis

Sci

2000; 41: 2486–2494. | 

PubMed

 | 

ISI

 | 

ChemPort

 |

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Refractive Disorders - Astigmatism

Stems from an abnormally curved CORNEA

Causes poor focus of light on the retina

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Refractive Disorders - Astigmatism

As a consequence, patients with significant astigmatism have blurred vision at all distances

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Refractive Disorders - Presbyopia

Also known as 'age related diffficulty in reading'

Caused by failure of the natural lens to accommodate

May result in eyestrain, and discomfort during near tasks

Occurs later in myopic people

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Refractive Disorders - Cataract

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Refractive Disorders - Cataract

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Refractive Disorders

Different Refractive Disorders Can Exist in the same eye

Methods of correction should ideally aim to correct everything simultaneously

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Non Surgical Correction

1. Leaving it alone

2. Spectacles

3. Contact Lenses

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Non Surgical Correction - Spectacles

Available widely and affordable/little maintenance compared to contact lenses

Available in

monofocal

options (Distance/Near or even Task specific)

Available in multifocal/

varifocal

options correcting everything

Unable to correct errors due to cataracts

May be unnecessarily heavy; hinders sports and outdoor activities

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Non Surgical Correction - Spectacles

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Non Surgical Correction – Contact Lenses

Available in

Monofocal

or Multifocal options

Allows correction of myopia/hyperopia/astigmatism and presbyopia simultaneously

Requires care and motivation in order to use safely

More expensive and requires more maintenance compared to spectacles

Unable to correct errors due to cataracts

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Surgical Correction

1. LASIK

2. Intraocular Lenses

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Surgical Correction - LASIK

Laser In-Situ

Keratomileusis

Surgical Reshaping of the cornea to correct refractive errors

Able to correct

significant Myopia/Astigmatism/Presbyopia

Unable to correct errors due to cataract

Advantages – Glasses/Contact Lens Free; extremely safe, quick procedure

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Surgical Correction - LASIK

In myopia, the curve of the cornea is often too STEEP or the eyeball is too LONG

In astigmatism, the curve of the cornea is UNEVEN

LASIK is able to correct these errors simultaneously

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Surgical Correction - LASIK

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Surgical Correction – Intraocular Lenses

Preferred choice to LASIK when a person has cataract (in addition to other refractive errors)

Monofocal

or Multifocal lenses

Monofocal

lenses usually correct for distance vision, requiring reading glasses for near tasks

Multifocal lenses allow for clear near and intermediate

vision in addition to distance vision

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Surgical Correction – Cataract Surgery and Intraocular Lenses

Monofocal

IOL

Multifocal IOL

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Surgical Correction – Cataract Surgery and Intraocular Lenses

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Surgical Correction – Cataract Surgery and Intraocular Lenses

Results are often excellent and well tolerated as long as care is taken to select appropriate patients

Many options in the market

Various options grant varying degrees of spectacle/CL freedom at different distances and lighting

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Surgical Correction – Cataract Surgery and Intraocular Lenses

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Conclusion

Refractive Disorders (with rare exceptions) are easily manageable

Surgical Options are widely available, safe and reliable

Excellent investment in advancing

age, because all we want in our older years is -

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Conclusion

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Thank You.