Refractive Correction for Age Related Vision Problems Dr. Julian Tagal FRCOphth Ophthalmologist, Sarawak General Hospital Visiting Ophthalmologist and LASIK Surgeon, Borneo Medical Centre

Financial Disclosure NONE

Aging – It Happens to Everyone

We can age badly.. Keith Richards

Or we can age gracefully.. Dame Helen Mirren

The choice is often up to us..

We are unable to disrupt aging…

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

And that means, understanding your body..

It’s very important to take care of your eyesight as you age.. ----- Meeting Notes (9/28/17 23:32) ----- This means - Perspective of an eye surgeon - being aware of common disorders that may affect us as we age

----- Meeting Notes (9/28/17 23:32) ----- Vision is important - All distances -All situations - Essential to maintain vision to maintain your quality of life

Social Relationships Health Environment Personal Safety Emotional Wellbeing Financial Wellbeing -thus to mainain QOL as we age, important to maintain Q of vision Belonging Work

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

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 And there are certain disorders of refraction that may occur as we age

What is Refraction First described by Persian mathematician and physicist, Ibn Sahl in AD 984 in 'Burning Mirrors and Lenses'

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

Functional Ocular Anatomy 1st Refracting Interface The construct of the eye is a study in refractive perfection 2nd Refracting Interface

How Does Anatomy Relate to refraction?

How does Anatomy Relate to Refraction? what about near objects? eye is mathematical construct if structure doesnt change, near objects fall behind accomodation maintains clear images

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

Refractive Disorders Refractive disorders are disorders of focus 1. Myopia (Short Sightedness) 2. Astigmatism 3. Presbyopia 4. Cataracts

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

Refractive Disorders - Myopia As a consequence, myopic people are only able to view near items clearly

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 olds1 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 |

Refractive Disorders - Astigmatism Stems from an abnormally curved CORNEA Causes poor focus of light on the retina

Refractive Disorders - Astigmatism As a consequence, patients with significant astigmatism have blurred vision at all distances

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 Cast mind back a few slides back Mathematical Construct intact - light from distance is seen clearly accommodation allows nearer objects remain in focus

Refractive Disorders - Cataract

Refractive Disorders - Cataract

Refractive Disorders Different Refractive Disorders Can Exist in the same eye Methods of correction should ideally aim to correct everything simultaneously Refractive disorders as a whole unusual in the aging eye to have only one often a few are present at the same time

Non Surgical Correction 1. Leaving it alone 2. Spectacles 3. Contact Lenses

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 Multifocal options correcting myopia, astigmatism and presbyopia

Non Surgical Correction - Spectacles

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

Surgical Correction 1. LASIK 2. Intraocular Lenses

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

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

Surgical Correction - LASIK

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

Surgical Correction – Cataract Surgery and Intraocular Lenses Monofocal IOL Multifocal IOL

Surgical Correction – Cataract Surgery and Intraocular Lenses

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 Monofocal lenses - forgiving Multifocal lenses, while potential benefits are immense not appropriate for everyone, inherent, glare, haloes, pilots, HGV drivers, not suitable

Surgical Correction – Cataract Surgery and Intraocular Lenses Just to demonstrate that while technology is brilliant, given our current options, there are often minor inherent weaknesses that make multifocal lenses unsuitable for some people

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 -

Conclusion

Thank You.