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    Opportunities and challenges in the world of ophthalmology in 2018


    Thoughts on management of presbyopia

    Dr Alio: Surgical management of presbyopia is both innovative and challenging and is constantly being renewed. However, there are many factors in the development of presbyopia, making it difficult to adequately manage it.

    Most surgical techniques that have been proposed for the surgical correction of this age-related disease are based on the acquirement of pseudoaccommodation. Accommodative intraocular lenses would be the ideal solution for presbyopia, having the power to resolve the inconvenience of the disease and the side effects produced by current surgical options.

    However, despite many attempts to restore accommodation via the use of IOLs, none of the lenses have demonstrated sufficient long-term efficacy, even though they initially created a stir in the scientific community. Some new models and ideas are arriving and we should pay attention to their first clinical results, but we should do so carefully to avoid repeating the same mistakes of the past.

    Dr Fazio: Presbyopia will probably remain the number one ophthalmic challenge in the refractive area for many years to come. These days the debate is about the new category of extended-depth-of-focus (EDOF) IOLs.

    These lenses claim to make it possible for patients to have a continuous or almost continuous range of focus, from far to intermediate, without (or almost without) visual disturbances. Lenses competing in the increasingly crowded EDOF market include Symfony (Technis), Lara (Zeiss) and the Mini WELL IOL (SIFI Medtech).

    With these lenses, worse near correction is traded for better far vision. But the question remains: how much worse does the near vision become and how big are the improvements to far vision?

    If these lenses could really compete shoulder to shoulder with a standard aspheric lens in order of far quality of vision, that would be really good. However, since even an EDOF IOL manipulates the incoming light, a certain amount of visual disturbance is to be taken into account. 

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