Clinical Scorecard: Trying to Avoid the Unavoidable
At a Glance
Category
Detail
Condition
Presbyopia, an age-related loss of near vision
Key Mechanisms
Age-related stiffening and loss of accommodation of the natural lens
Target Population
Adults typically starting in their early to mid-40s, including high myopes and hyperopes
Care Setting
General ophthalmology and refractive surgery clinics
Key Highlights
Presbyopia is unavoidable and affects nearly 130 million Americans.
Personalized, age- and refractive error-dependent approaches are essential for treatment.
Advanced IOL technologies and nonsurgical options expand treatment choices but require careful expectation management.
Guideline-Based Recommendations
Diagnosis
Evaluate patient age, lens status, and refractive errors (myopia, hyperopia).
Assess patient goals and lifestyle to guide treatment selection.
Management
Consider refractive lens exchange with advanced IOLs (monofocal, multifocal, toric, extended depth of focus, accommodative, Light Adjustable Lens) especially in patients 45 years and older.
Use phakic IOLs as an off-label option for high myopes over 45 as a bridge treatment.
Trial monovision with contact lenses or laser vision correction to assess tolerance before surgical intervention.
Offer nonsurgical options including glasses, contact lenses, and presbyopia drops (pending FDA approval).
Educate patients that LASIK may not directly treat presbyopia in all cases.
Consider laser scleral microporation as investigational.
Monitoring & Follow-up
Monitor for retinal complications, especially in high myopes at risk for retinal detachment.
Manage ocular surface and dry eye disease pre- and postoperatively to optimize outcomes.
Follow up for adaptation to multifocal lenses and address visual disturbances.
Be prepared for additional procedures such as laser capsulotomy or astigmatism fine-tuning.
Risks
Risks similar to cataract surgery including floaters and retinal problems.
Potential need for adaptation period with multifocal IOLs.
Possible requirement for secondary procedures to optimize vision.
Patient & Prescribing Data
Adults in their 40s to 70s with presbyopia, including high myopes and hyperopes
Patients increasingly seek earlier intervention with advanced IOL technologies; careful patient selection and expectation setting are critical to satisfaction.
Clinical Best Practices
Use a personalized approach considering age, refractive error, lens status, and patient goals.
Set realistic expectations emphasizing that artificial lenses differ from the natural lens.
Trial monovision nonsurgically before surgical commitment.
Optimize ocular surface health to improve surgical outcomes.
Educate patients about the adaptation period and potential need for additional procedures.
