1/7. A complication of scleral expansion surgery for treatment of presbyopia.PURPOSE: To report a patient who developed complications from an experimental technique using scleral expansion to treat presbyopia. methods: Case report of a 46-year-old woman who underwent scleral expansion surgery on her right eye. Postoperatively, the patient developed chronic pain and swelling that necessitated removal of the scleral expanders. RESULTS: After removal of the scleral expanders, the patient demonstrated a -1.4 diopter myopic shift in the right eye relative to her preoperative refraction. Axial length of the right eye was 1.15 mm longer than of the left, whereas preoperative axial lengths were equal. CONCLUSION: This patient developed scleral thinning with resultant axial lengthening and myopic shift, akin to the phenomenon observed with scleral buckles used to treat retinal detachments. We believe this was responsible for improved near vision in her right eye, rather than any increased accommodative potential purported to result from this operation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/7. presbyopia complicating pre-existing strabismus.BACKGROUND: presbyopia may affect pre-existing sensory adaptations or aggravate previously asymptomatic heterophoria. We describe the presentation, underlying problem and management of 11 patients with pre-existing strabismus or heterophoria who presented with new symptoms of double vision attributable to presbyopic change, an association not previously reported. methods: patients with new strabismic symptoms attributable to presbyopia were recruited prospectively over a 1-year period. RESULTS: The 11 patients had had a recent decrease of accommodative amplitude that resulted in blurred vision at near with a breakdown of pre-existing heterophoria (2 patients), alteration of fixation pattern (6 patients), symptomatic alternating fixation (2 patients) or intolerance to correction owing to restrictive strabismus (1 patient). INTERPRETATION: At the onset of presbyopia, symptoms may be varied and subtle. Ophthalmologists and orthoptists should carefully determine the exact nature of the symptoms. Any pre-existing fixation pattern should then be established from the history, old photographs or suppression characteristics. Refractive or surgical management should be aimed at returning the patient to his or her long-standing sensory adaptation. Other important issues, such as incomplete correction of hypermetropia by refractive surgery and problems using bifocals with vertical restrictive strabismus, should be noted.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
3/7. Imaging scleral expansion bands for presbyopia with optical coherence tomography.A 57-year-old woman was treated for mild presbyopia with implantation of scleral expansion bands (SEB). Although near vision was temporarily restored, the effect dissipated after 1 year. Slitlamp-adapted optical coherence tomography (OCT) at 1310 nm allowed precise cross-sectional visualization of the hyporeflective intrascleral segments. The OCT method provided precise images of the segment depth and thickness, the scleral thickness at the scleral spur, the anterior chamber angle, and the angle-opening distance. Intrascleral tilting of 1 segment was seen; this required removal of the SEB because of marked foreign-body sensation. Noncontact, slitlamp-adapted OCT can be used to evaluate scleral changes after SEB implantation.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/7. Prandial presbyopia: the muffin man.Transient blurring of near vision can be due to a variety of causes. We report the case of a 35-year-old man with a 10-year history of blurring of near vision that begins 30 to 45 seconds after he starts to eat and that lasts until 10 to 15 minutes after he stops eating. magnetic resonance imaging and computed tomography of the brain and orbits did not reveal any abnormality, and stimulation of individual cranial nerves did not result in a loss of near vision. Retinoscopic refraction revealed the loss of 1.5 dioptres of accommodative power in each eye one minute after he began to eat. To the best of our knowledge such blurring of vision at near, immediately after initiating a meal, has not been previously reported. The neuroanatomy of the accommodation and of the gustatory pathways are discussed, as they may relate to this patient's visual complaint.- - - - - - - - - - ranking = 4keywords = near (Clic here for more details about this article) |
5/7. Induced hyperphoria in anisometropic presbyopia.anisometropia occurring either as a result of physiological or acquired etiologies may present a challenge to the optometrist if the patient is presbyopic. Fortunately, many patients with anisometropic presbyopia are able to adapt to near induced hyperphoria. There are, however, several options available for the optical management of symptomatic patients with near induced hyperphoria. These include: displacement of the distance optical centers, setting the bifocal segment higher than usual, using a combination of these two, dissimilar bifocal segments, slab-off prism and contact lenses. This paper reviews clinical considerations as well as the available spectacle management options.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
6/7. The use of dissimilar progressives in the management of presbyopia.The management of anisophoria with bifocal spectacle correction has always presented a challenging refractive problem. Historically, practitioners have used dissimilar bifocal segments or bicentric grinding to neutralize induced vertical imbalance. We present a method of reducing anisophoria at near point with dissimilar progressive multifocals. By incorporating different progressive designs, anisophoria can be minimized to a tolerable level, based on the dioptric power of lens and progressive lens design.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/7. Contraction of a perifoveal epiretinal membrane simulating a macular hole.Four patients observed for a three- to four-year period had a hole in an epiretinal membrane overlying the macula that mimicked a macular hole. In two patients the clinical appearance remained essentially constant. In one, the epiretinal membrane contracted further, reducing the apparent macular hole to a slit and causing the typical appearance of a macular pucker. In the fourth patient, the epiretinal membrane peeled spontaneously causing the apparent hole to disappear. None of the patients had static perimetric findings that suggested a true macular hole. All of the patients had normal or nearly normal visual acuity when first seen. This was maintained except in the patient who suffered further membrane contraction. fluorescein angiography demonstrated a slight fluorescence in the base of the hole in three of the four patients; however, it was not as pronounced as one sees in true macular holes. Lamellar macular holes characteristically show no fluorescence in the area of the hole.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |