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

2. Financial Disclosure
NONE

3. Aging – It Happens to Everyone

4. We can age badly..
Keith Richards

5. Or we can age gracefully..
Dame Helen Mirren

6. The choice is often up to us..

7. We are unable to disrupt aging…

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

9. And that means, understanding your body..

10. It’s very important to take care of your eyesight as you age..
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This means
- Perspective of an eye surgeon
- being aware of common disorders that may affect us as we age

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Vision is important
- All distances
-All situations
- Essential to maintain vision to maintain your quality of life

12. 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

13. 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

14. 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

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

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

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

18. How Does Anatomy Relate to refraction?

19. 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

20. 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

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

22. 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

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

24. 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 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 |

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

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

27. 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

28. Refractive Disorders - Cataract

29. Refractive Disorders - Cataract

30. 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

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

32. 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

33. Non Surgical Correction - Spectacles

34. 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

35. Surgical Correction
1. LASIK
2. Intraocular Lenses

36. 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

37. 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

38. Surgical Correction - LASIK

39. 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

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

41. Surgical Correction – Cataract Surgery and Intraocular Lenses

42. 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

43. 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

44. 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 -

45. Conclusion

46. Thank You.