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Scleral surgery for the treatment of presbyopia: where are we today?

Eye and Vision 2018年第1期5卷 37-47页

作者： annmarie hipsley Brad Hall Karolinne M.Rocha Ace Vision Group Inc 39655 Eureka DriveNewarkCA 94560USA Sengi Data CambridgeONCanada Storm Eye Institute Medical University of South CarolinaCharlestonSCUSA

Presbyopia corrections traditionally have been approached with attempts to exchange power,either at the cornea or the lens planes,inducing multifocality,or altering asphericity to impact the optical *** that affect the visual axis,such as spectacle and contact lens correction,refractive surgeries,corneal onlays and inlays,and intraocular lenses are typically unable to restore true accommodation to the presbyopic *** aim is instead to enhance‘pseudoaccommodation’by facilitating an extended depth-of-focus for which vision is *** is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution,rather than a‘vision correction’solution that compromises other components of the optical *** surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat *** the theoretical justification of scleral surgical procedures remains controversial,there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat *** progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s,and this remains an active area of *** this article,we discuss the historic scleral surgical procedures,the two scleral procedures currently available,as well as an outlook of the future for the scleral surgical space for treating presbyopia.

关键词： Scleral surgery Presbyopia Accommodation Presbyopia treatment

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Visual outcomes 24 months after LaserACE

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Eye and Vision 2017年第1期4卷 70-80页

作者： annmarie hipsley David Hui-Kang Ma Chi-Chin Sun Mitchell A.Jackson Daniel Goldberg Brad Hall Ace Vision Group Inc 39655 Eureka DriveNewarkCA 94560USA Department of Ophthalmology Chang Gung Memorial HospitalKweishanTaoyuanTaiwan Department of Chinese Medicine Chang Gung UniversityKweishanTaoyuanTaiwan Center for Tissue Engineering Chang Gung Memorial HospitalKweishanTaoyuanTaiwan Department of Ophthalmology Chang Gung Memorial HospitalKeelungTaiwan Jackson Eye Lake VillaILUSA Drexel College of Medicine PhiladelphiaPAUSA Sengi Data CambridgeONCanada

Background:To evaluate the effects on near and intermediate visual performance after bilateral Laser Anterior Ciliary Excision(LaserACE)***:LaserACE surgery was performed using the VisioLite 2.94μm erbium:yttrium-aluminum-garnet(Er:YAG)ophthalmic laser system in 4 oblique quadrants on the sclera over the ciliary muscle in 3 critical zones of physiological importance(over the ciliary muscles and posterior zonules)with the aim to improve natural dynamic accommodative *** was performed on 26 patients(52 eyes).Outcomes were analyzed using visual acuity testing,Randot stereopsis,and the CatQuest 9SF patient ***:Binocular uncorrected near visual acuity(UNVA)improved from+0.20±0.16 logMAR preoperatively,to+0.12±0.14 logMAR at 24 months postoperatively(p=0.0014).There was no statistically significant loss in distance corrected near visual acuity(DCNVA).Binocular DCNVA improved from+0.21±0.17 logMAR preoperatively,to+0.11±0.12 logMAR at 24 months postoperatively(p=0.00026).Stereoacuity improved from 74.8±30.3 s of arc preoperatively,to 58.8±22.9 s of arc at 24 months postoperatively(p=0.012).There were no complications such as persistent hypotony,cystoid macular edema,or loss of best-corrected visual acuity(BCVA).Patients surveyed indicated reduced difficulty in areas of near vision,and were overall satisfied with the ***:Preliminary results of the LaserACE procedure show promising results for restoring visual performance for near and intermediate visual tasks without compromising distance vision and without touching the visual *** visual function and visual acuity improvements had clinical *** satisfaction was high postoperatively and sustained over 24 months.

关键词： Presbyopia Accommodation Clinical trial Asian eyes Visual acuity

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