The surgical correction of presbyopia : Accommodation , pseudo - accommodation or multifocality ?

“It is undoubtedly the final frontier of cataract and refractive surgery.There is great interest and excitement in this field of research at the moment and we are seeing some very interesting approaches coming on stream which hold great promise for future treatment of presbyopia,” said David Spalton FRCS, FRCOphth, who co-chaired the symposium. Dr Spalton said it was important to remember that there is more to near vision than just accommodation and that clinicians should be aware of other factors that might have a bearing on outcomes such as IOLrelated factors, pupillary miosis and monovision in pseudo-accommodation, contrast and illumination, testing conditions and patient subjectivity. “It is vital that we have a critical assessment of near vision.We need to know what psychophysical tests we should be doing and because they are subjective it is important that we have placebo controls. Equally important is that we need to have objective measurements in these patients of dioptric change and IOL position. If we believe an IOL is moving we need to be able to measure that,” he said. Dr Spalton said that clinicians also needed to bear in mind the effect of capsular bag fibrosis, the role of lens epithelial cells and the effect of YAG capsulotomy on their presbyopic patients. “Are we going to have to destroy the lens epithelial cells in order to be able to restore accommodation, and if we do that, what are the consequences going to be in maintaining the capsular bag? Can we maintain the capsular bag without viable cells in it? We are making a lot of progress, in the challenge of restoring accommodation with surgery, but there is still much to be done,” he said.