Graefes Arch Clin Exp Ophthalmol. 2007 Dec 11 [Epub ahead of print]
The value of vision.
Knauer C, Pfeiffer N.
Universitäts-Augenklinik, Langenbeckstrasse 1, Gebäude 102, 55131, Mainz, Germany, knauer@augen.klinik.uni-mainz.de.

BACKGROUND: The value of vision is assumed to be very high. To verify this assumption and to assign resources in medical care accordingly, it is necessary to quantify the value of vision. Although the value of vision is difficult to measure, visual quality of life can be quantified as a surrogate criterion. The measured value gains even more relevance if a comparison can be made between visual quality of life and systemic diseases. Multidisciplinary comparisons are only possible by using utility analysis. Two established methods to measure utility values are the standard gamble method and the time trade-off method. The purpose of this review is to find ophthalmologic utility values, and utility values affected by systemic diseases that correlate to the ophthalmologic ones.

METHODS: A literature search was conducted though PubMed of the National Library of Medicine ( http://www.ncbi.nlm.nih.gov ; date: 06.02.2006). The search terms were: "time trade-off / standard gamble" [text word] and "eye / vision / visual" [text word]; results 24. A report was classified as relevant if visually impaired persons were tested by the time trade-off method or the standard gamble method, or if information was provided on the reliability and validity of these measurements in a group of visually impaired persons. Additional searches were done to find associated publications. A total of 42 publications were found to be of interest.

RESULTS: Results showed that patients, with 20/30-20/50 visual acuity would be willing to pay 19% of their lifetime to get back normal visual acuity. Patients with 20/200-20/400 visual acuity would give up 48% of their lifetime, and blind people would give 60% of their lifetime to regain normal visual acuity. Comparable utility values are seen in patients with AIDS (21%), patients after a stroke who are unable to walk and wash themselves without assistance (46%), and bedridden and incontinent patients following a stroke (66%).

CONCLUSION: Patients attach great value to vision. The time trade-off method appears to be an appropriate tool to quantify visual quality of life, and one that can be used to compare utility values of different diseases.

Am J Ophthalmol. 2008 Jan 26 [Epub ahead of print]
Changes in the Quality-of-Life of People with Keratoconus.
Kymes SM, Walline JJ, Zadnik K, Sterling J, Gordon MO; on behalf of the Collaborative Longitudinal Evaluation of Keratoconus Study Group.
Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri; Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri; Center for Health Policy, Washington University, St Louis, Missouri.

PURPOSE: The Collaborative Longitudinal Evaluation of Keratoconus Study (CLEK) previously showed that people with keratoconus report significantly impaired vision-related quality-of-life (V-QoL), as measured on the National Eye Institute Visual Function Questionnaire (NEI-VFQ), similar to that of people who have severe macular degeneration. For this study, we evaluated changes that occurred in V-QoL over seven years of follow-up.

DESIGN: In this prospective cohort study of 1,166 participants followed up for seven years, we estimated change in V-QoL by projecting the slope of a minimum of three reports on 11 scales of the NEI-VFQ. Correlation with clinical indicators was evaluated, and differences were assessed between those who had clinically significant changes in clinical factors and those who did not. Logistic regression was used to assess factors associated with a decline in 10 points or more in a scale score over seven years.

RESULTS: All scales showed modest decline except ocular pain and mental health. Baseline factors were not associated with longitudinal change in NEI-VFQ scores. A 10-letter decline in high-contrast binocular visual acuity or a 3.00-diopter increase in corneal curvature were associated with significantly larger declines in V-QoL. In multivariate analysis, these factors also were found to be associated with a 10-point decline in NEI-VFQ scale scores.

CONCLUSIONS: Keratoconus is associated with significantly impaired V-QoL that continues to decline over time. For a substantial plurality of patients, these declines are significant.

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Eye Contact Lens. 2008 Jan;34(1):13-6.
The disease burden of keratoconus in patients' lives: comparisons to a Japanese normative sample.
Tatematsu-Ogawa Y, Yamada M, Kawashima M, Yamazaki Y, Bryce T, Tsubota K.
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

PURPOSE: Keratoconus is a chronic, noninflammatory, degenerative disease of the cornea that has an onset in young adulthood. The objective of this study was to evaluate vision-related quality of life (VR-QOL) in patients with keratoconus by using the Japanese version of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25).

METHODS: Forty-five patients diagnosed with keratoconus at the Keio University School of Medicine were enrolled. Patients were divided into three subgroups according to corrected visual acuity. Group A included patients whose best-corrected visual acuity was at least 20/20 in both eyes. Group B included patients with a best-corrected visual acuity of at least 20/20 in only one eye. Group C included patients whose best-corrected visual acuity was worse than 20/20 in both eyes. Thirty-six age-matched subjects were recruited as control subjects. The Japanese version of the NEI-VFQ-25 was administered to each subject.

RESULTS: All NEI-VFQ-25 subscale scores were significantly lower (P<0.05) in patients with keratoconus than in the control subjects. Subscales evaluating general health, ocular pain, and vision-specific mental health showed particularly low values. Among patients with keratoconus, every subscale score other than color vision correlated with corrected visual acuity.

CONCLUSIONS: The results support that and describe how multidimensional visual function and VR-QOL are impaired in patients with keratoconus, including those with normal visual acuity. Ophthalmologists and other clinicians should carefully evaluate and address the full range of quality of life issues that may affect patients with keratoconus.

Optom Vis Sci. 2007 Nov;84(11):1024-30.
Depression in older people: visual impairment and subjective ratings of health.
Hayman KJ, Kerse NM, La Grow SJ, Wouldes T, Robertson MC, Campbell AJ.
Department of General Practice and Primary Health Care, School of Population Health, The University of Auckland, Auckland, New Zealand. k.hayman@auckland.ac.nz

PURPOSE: The aim of this study was to establish the prevalence of depression in a sample of older adults with impaired vision and investigate associations between physical and visual disability and depression.

METHODS: We analyzed cross-sectional baseline data from 391 participants aged >or=75 years with visual acuity of 6/24 (20/80) or less, recruited for a randomized controlled trial of interventions to prevent falls (the VIP trial). Measures included the geriatric depression scale (GDS-15), the state-trait anxiety index, activities of daily living (Nottingham extended ADL scale), physical activity (human activity profile), an index of visual functioning (VF-14), health-related quality of life (SF-36), objective measures of physical ability, and a measure of visual acuity. Regression models were developed to investigate the association between depression scores and physical, psychological, and visual disability.

RESULTS: About 29.4% (115 of 391) of participants were identified as potentially depressed (GDS-15 score >4). Physical function, physical activity, physical ability, visual function, anxiety, and self-reported physical and mental health were significantly worse for those with depressive symptomatology. Physical, visual, and psychological factors collectively explained 41% of the variance in the depression score in a linear regression model (R=0.421, adjusted R=0.410, F (7,382)=39.680, p<0.001). Depression was not related to age, gender, living situation, ethnicity, or number of prescription or antidepressant medications taken.

CONCLUSIONS: Depression was common in this population of older adults with severe visual impairment. Impaired visual and physical functions were associated with symptoms of depression. The effect of visual disability was independent of the effect of physical disability. The strength of this relationship, and the results of the regression analyses, indicate that a person who is visually or physically disabled is more likely to suffer from depression.

Arch Ophthalmol. 1993 May;111(5):680-5.

Vision change and quality of life in the elderly. Response to cataract surgery and treatment of other chronic ocular conditions.

Brenner MH, Curbow B, Javitt JC, Legro MW, Sommer A.
School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Md.

OBJECTIVE--Evaluation of health care in older populations has increasingly focused on quality of life as a critical outcome of treatment. Vision is assumed to be central to functioning. Data suggest that aging, in itself, is associated with a decline in visual functioning, which, in turn, is related to a decline in physical and mental functioning. Other studies indicate that cataract surgery is followed by significant improvement in vision and visual function. Our objective was to test these assumptions.

DESIGN--Prospective study of 1021 patients, consecutively drawn from 76 randomly selected ophthalmologists' offices in three cities. Structured interviews were completed at baseline, 2 months, and 1 year after entry.

PATIENTS--Six hundred thirteen patients with cataracts and 408 other ophthalmic patients drawn from the same offices but treated for other chronic ocular disorders. All received refractive services as needed.

SETTING--Patients from three cities (Baltimore, Md, St Louis, Mo, and San Diego, Calif) were interviewed once in their homes and twice by telephone.

INTERVENTIONS--The study involved the measurement of the effects of usual treatment for cataracts and other degenerative eye diseases.

MAJOR OUTCOME MEASURES--Visual, social, and psychological functioning.

RESULTS--Within 1 year of treatment, change in visual function was accompanied by significant changes, in the same direction, in quality of life functions: night-time driving, daytime driving, community activities, home activities, mental health, and life satisfaction. In addition, the patients with cataracts showed significantly greater improvement in measures of vision than did the noncataract group.

CONCLUSIONS--Regardless of treatment, improvement across quality of life functions occurred when visual function improved. Thus, many types of functional degeneration observed in older populations, attributed to a decline in vision, can be slowed, or even reversed, when visual function is improved. Cataract surgery was effective in improving vision and quality of life functions.

Psychosomatics. 1999 Jul-Aug;40(4):339-44.

Blindness, fear of sight loss, and suicide.

De Leo D, Hickey PA, Meneghel G, Cantor CH.
Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia.

Numerous studies have examined the emotional impact exerted by sight loss. Research has tended to focus on clinical-diagnostic rather than therapeutic-preventive aspects. Blindness and sight restoration have been reported to induce both temporary and longer term psychopathology, usually followed by psychosocial readjustment. However, in some cases, readjustment may not occur and suicide may result. Together with an extensive review of available literature, the authors present cases taken from their psychological autopsy study database. When compared with a hearing-impaired control group, impaired sight alone can acutely affect otherwise psychologically healthy individuals. Ophthalmologists need to be aware of this problem and to develop closer collaboration with mental health professionals. Serious consideration of this problem and definition of clear guidelines may prevent suicidal behaviour.

See full text at
http://www.lasik-flap.com/suicide_paper.pdf

Quinto GG, Camacho W, Behrens A. Postrefractive surgery dry eye. Curr Opin Ophthalmol. 2008 Jul;19(4):335-41.

Ophthalmology. 2003 Jul;110(7):1412-9.
Comment in:
Ophthalmology. 2004 Apr;111(4):852-3; author reply 853.
Utility assessment among patients with dry eye disease.
Schiffman RM, Walt JG, Jacobsen G, Doyle JJ, Lebovics G, Sumner W.
Allergan, Inc., 2525 Dupont Drive, Irvine, CA 92623-9534, USA.

PURPOSE: To determine utilities (patient preferences) for dry eye disease. DESIGN: Survey study.

PARTICIPANTS: Fifty-six patients with mild, moderate, or severe dry eye treated by ophthalmologists in the Eye Care Services department of Henry Ford Health Care System.

TESTING: Patients completed interactive software utility assessment questionnaires by the time trade-off (TTO) method. Utility scores were scaled such that a score of 1.0 = perfect health and 0 = death. Dry eye severity was independently classified using clinical parameters and physician/patient assessments. Global health status, visual functioning, and ocular symptoms were assessed by the Short Form-36 Health Survey, 25-Item National Eye Institute Visual Function Questionnaire (NEI VFQ-25), and Ocular Surface Disease Index survey instruments.

MAIN OUTCOME MEASURES: Utility scores for a range of dry eye severity states. These utilities were compared with utilities reported for other disease states. Correlations with the general and vision-related health status measures were conducted.

RESULTS: Fifty-six patients completed the utility assessments with acceptable reliability. Mean utilities for moderate (0.78) and severe dry eye (0.72) by TTO were similar to historical reports for moderate (0.75) and more severe (class III/IV) angina (0.71), respectively. Utility scores correlated with the NEI VFQ-25 composite score (rho = 0.32; P = 0.037) and with components of other health measures.

CONCLUSIONS: Utilities for the more severe forms of dry eye are in the range of conditions like class III/IV angina (0.71) that are widely recognized as lowering health utilities. Our results underscore how significantly dry eye impacts patients compared with other medical conditions.

http://www.osnsupersite.com/woc/woc_day2.pdf

Study finds that even mild disease impacts glaucoma patients’ quality of life

http://archopht.ama-assn.org/cgi/content/full/126/7/975

Reported Visual Impairment and Risk of Suicide
The 1986-1996 National Health Interview Surveys

Byron L. Lam, MD; Sharon L. Christ, MS; David J. Lee, PhD; D. Diane Zheng, MS; Kristopher L. Arheart, EdD

Arch Ophthalmol. 2008;126(7):975-980.



http://www.medicalnewstoday.com/articles/114771.php

Am J Ophthalmol. 2008 Jul 2. [Epub ahead of print]
The Impact of Cataract Surgery on Cognitive Impairment and Depressive Mental Status in Elderly Patients.Ishii K, Kabata T, Oshika T.
Department of Ophthalmology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan; Division of Ophthalmology, Mito Saiseikai General Hospital, Ibaraki, Japan.

PURPOSE: To evaluate the influence of cataract surgery on cognitive function and depressive mental status of elderly patients.

DESIGN: Prospective, interventional case series.

METHODS: The 25-Item National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25), Mini-Mental State Examination (MMSE), and Beck Depression Inventory (BDI) are the measures designed to assess vision-related quality of life (QOL), cognitive impairment, and depressive mental status, respectively. These tests were performed before and two months after surgery in 102 patients undergoing phacoemulsification and intraocular lens implantation for bilateral cataract.

RESULTS: The change in best-corrected visual acuity by surgery significantly correlated with the change in NEI VFQ-25 score (Pearson correlation, r = -0.310; P = .031). The change in NEI VFQ-25 score by surgery significantly correlated with the change in MMSE score (r = 0.306; P = .035) and the change in BDI score (r = -0.414; P < .001). The change in MMSE score showed significant correlation with the change in BDI score (r = -0.434; P < .001).

CONCLUSIONS: Vision-related QOL, cognitive impairment, and depressive mental status are all strongly related with each other. Cataract surgery significantly improved vision-related QOL in elderly patients, and cognitive impairment and depressive mental status also improved in parallel with improvement in vision-related QOL.

Invest Ophthalmol Vis Sci. 2008 Aug;49(8):3318-23. Epub 2008 Mar 24.

Assessment of the effect of visual impairment on mortality through multiple health pathways: structural equation modeling.

Christ SL, Lee DJ, Lam BL, Zheng DD, Arheart KL.
Odum Institute, University of North Carolina, Chapel Hill, North Carolina 27599-3355, USA. slchrist@email.unc.edu

PURPOSE: To estimate the direct effects of self-reported visual impairment (VI) on health, disability, and mortality and to estimate the indirect effects of VI on mortality through health and disability mediators.

METHODS: The National Health Interview Survey (NHIS) is a population-based annual survey designed to be representative of the U.S. civilian noninstitutionalized population. The National Death Index of 135,581 NHIS adult participants, 18 years of age and older, from 1986 to 1996 provided the mortality linkage through 2002. A generalized linear structural equation model (GSEM) with latent variable was used to estimate the results of a system of equations with various outcomes. Standard errors and test statistics were corrected for weighting, clustering, and stratification.

RESULTS: VI affects mortality, when direct adjustment was made for the covariates. Severe VI increases the hazard rate by a factor of 1.28 (95% CI: 1.07-1.53) compared with no VI, and some VI increases the hazard by a factor of 1.13 (95% CI: 1.07-1.20). VI also affects mortality indirectly through self-rated health and disability. The total effects (direct effects plus mediated effects) on the hazard of mortality of severe VI and some VI relative to no VI are hazard ratio (HR) 1.54 (95% CI: 1.28-1.86) and HR 1.23 (95% CI: 1.16-1.31), respectively.

CONCLUSIONS: In addition to the direct link between VI and mortality, the effects of VI on general health and disability contribute to an increased risk of death. Ignoring the latter may lead to an underestimation of the substantive impact of VI on mortality.

J Glaucoma. 2008 Oct-Nov;17(7):546-51.

Depression and quality of life in patients with glaucoma: a cross-sectional analysis using the Geriatric Depression Scale-15, assessment of function related to vision, and the Glaucoma Quality of Life-15.

Skalicky S, Goldberg I.
Eye Associates, Sydney Eye Hospital, Sydney, Australia.

PURPOSE: To determine the prevalence of depression and its association with visual field impairment, quality of life, objective assessment of visual function, and glaucoma severity in elderly patients with glaucoma.

DESIGN: Cross-sectional study.

PARTICIPANTS AND CONTROLS: One hundred sixty-five patients with mild (n=60), moderate (n=43), or severe (n=28) glaucoma and 34 controls with ocular hypertension were enrolled. Severity was stratified according to the Nelson Glaucoma Severity Scale (based on the degree of binocular visual field loss). Groups were substratified according to age.

METHODS: Demographic information was collected via interviews; the Geriatric Depression Scale-15 and Glaucoma Quality of Life-15 (GQL-15) questionnaires were administered. Visual function was assessed by clinical examination and visual field testing. A subset of patients (n=68) underwent objective assessment of function related to vision. Group differences were evaluated using analysis of variance; Kruskall-Wallis analysis of ranks was performed with significance set at P<0.05. Age-adjustment of P values was performed using analysis of covariance for parametric data and Kruskall-Wallis analysis on age-stratified nonparametric data. A binary univariate regression analysis modeled depression to suspected risk factors. Significant predictive variables were modeled in a multivariate regression analysis.

RESULTS: Depression was more prevalent with increasing glaucoma severity, reaching statistical significance in patients aged 70 to 79 years (P<0.02). Summary and subfactor GQL-15 scores reflected decreased quality of life with increasing glaucoma severity. Assessment of function related to vision scores indicated worsening visual function with increasing glaucoma severity. On multivariate regression analysis, depression status was correlated with age and GQL-15 summary score.

CONCLUSIONS: Depression is more common in patients with increasing glaucoma severity (age, 70 to 79 y). In patients with glaucoma or ocular hypertension, age and GQL-15 summary score are independent risk factors for depression.

Dry eye studies:

Mertzanis P, Abetz L, Rajagopalan K, Espindle D, Chalmers R, Snyder C, Caffery B, Edrington T, Simpson T, Nelson JD, Begley C. The relative burden of dry eye in patients' lives: comparisons to a U.S. normative sample. Invest Ophthalmol Vis Sci. 2005 Jan;46(1):46-50.

Buchholz P, Steeds CS, Stern LS, Wiederkehr DP, Doyle JJ, Katz LM, Figueiredo FC. Utility assessment to measure the impact of dry eye disease. Ocul Surf. 2006 Jul;4(3):155-61.

Miljanović B, Dana R, Sullivan DA, Schaumberg DA. Impact of dry eye syndrome on vision-related quality of life. Am J Ophthalmol. 2007 Mar;143(3):409-15.

http://www.nei.nih.gov/news/pressreleases/031308.asp

News and Events
Contact:
National Eye Institute
(301) 496-5248
neinews@nei.nih.gov

NEI Press Release
NATIONAL INSTITUTES OF HEALTH
National Eye Institute
For Immediate Release March 13, 2008

Survey Shows Americans Lack Critical Facts about Maintaining Eye Health
Disparities are Greatest among Hispanics

Most Americans do not know the risks and warning signs of diseases that could blind them if they don't seek timely detection and treatment, according to recent findings of the Survey of Public Knowledge, Attitudes, and Practices Related to Eye Health and Disease. This survey was sponsored by the National Eye Institute, one of the National Institutes of Health, and the Lions Clubs International Foundation.

Seventy-one percent of respondents reported that a loss of their eyesight would rate as a 10 on a scale of 1 to 10, meaning that it would have the greatest impact on their day-to-day life. However, only eight percent knew that there are no early warning signs of glaucoma, a condition that can damage the eye's optic nerve and result in vision loss and blindness.

Fifty-one percent said that they have heard that people with diabetes are at increased risk of developing eye disease, but only 11 percent knew that there are usually no early warning signs. Only 16 percent had ever heard the term "low vision," which affects millions of Americans. Low vision is vision loss that standard eyeglasses, contact lenses, medicine, or surgery cannot correct, making everyday tasks difficult to do. Simple tasks like reading the mail, watching TV, shopping, cooking, and writing become challenging.

Hispanic respondents reported the lowest access to eye health information, knew the least about eye health, and were the least likely to have their eyes examined among all racial/ethnic groups participating in the survey. Forty-one percent of Hispanics reported that they had not seen or heard anything about eye health or disease in the last year, compared with 28 percent of Asians, 26 percent of African-Americans, and 16 percent of Caucasians.

More than 3,000 adults were selected randomly to participate in this national telephone survey conducted between October 2005 and January 2006. The findings reinforce the critical need to educate the public about common eye diseases, such as glaucoma, diabetic eye disease, and age-related macular degeneration.

"Good eyesight is important to our quality of life and it is essential for adults to have accurate information to help them make informed decisions about their eye health needs," said Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute (NEI), one of the National Institutes of Health. "These survey results will help us identify specific ways in which we can close the gap in knowledge about eye diseases and address the disparities that exist."

NEI plans to use the survey results to develop ways to raise public awareness of eye disease and the importance of early detection and treatment. NEI also will expand its educational outreach to Hispanics.

In addition, NEI will increase its efforts to educate health care providers on how to communicate with patients about ways to preserve and protect their vision. "The survey shows us that nearly one quarter of Americans have not seen or heard anything about eye health or disease, and yet more than 90 percent have seen a health care provider," Sieving said. "We need to educate these doctors, nurses, and other health care professionals with the tools they need to educate their patients on how to better maintain their eye health."

NEI coordinates the National Eye Health Education Program (NEHEP) in partnership with a variety of public and private organizations that conduct eye health education programs. The focus of NEHEP is on public and professional education programs that encourage early detection and timely treatment of glaucoma and diabetic eye disease and the appropriate treatment for low vision.

Lions Club International Foundation developed the Lions Eye Health Program, a community-based education program for Lions clubs, other community organizations, and individuals to promote healthy vision and to raise awareness of the causes of preventable vision loss. The mission of this Program is to empower communities to save sight through the early detection and timely treatment of glaucoma and diabetic eye disease, encourage those at higher risk to get a dilated eye exam, and educate those with low vision and their caregivers about these conditions.

"Lions have long been champions of people who are blind and visually impaired. By better educating the public on the need for regular eye exams and timely treatment of eye diseases, we can end preventable blindness," said Jimmy Ross, Chairperson, LCIF.

For the full report, visit: www.nei.nih.gov/kap/.

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2005 Survey of Public Knowledge, Attitudes, and Practices (KAP) Related to Eye Health and Disease

The National Eye Institute (NEI) and the Lions Clubs International Foundation (LCIF) conducted a national survey to assess public knowledge, attitudes and practices around eye health and disease. More than 3,000 adults were selected at random to participate in this national telephone survey which was conducted between October 2005 and January 2006. The findings reinforce the critical need to educate the public about common eye diseases, such as glaucoma, diabetic eye disease, and age-related macular degeneration.

Key findings:

Most Americans do not know the risks and warning signs of diseases that could blind them.

Only 8% knew that there are no early warning signs of glaucoma.

Only 16% had ever heard of the term low vision, which is vision loss that neither eyeglasses nor medical therapies can help.

More than 70% surveyed say that a loss of their eyesight would have the greatest impact on their day-to-day life.

Many said they consider the loss of eyesight to be worse than losing an arm or leg, or the ability to hear or speak.

Hispanics knew the least about eye health.

Hispanics were the least likely to have their eyes examined.

41% said that they had not seen or heard anything about eye health or disease in the last year.

http://www.nei.nih.gov/kap/2005KAPExecSumm.pdf

http://www.nei.nih.gov/kap/2005KAPFinalRpt.pdf

NEI and the Lions Clubs recommend that people get their eyes examined regularly by a health care provider. Regular eye examinations will help protect people's vision by detecting eye diseases early they are most effectively treated.

For more information about the KAP study, please call 301-496-5248 or email us at 2020@nei.nih.gov.

The following article states that visual difficulties from presbyopia has emotional repercussions. If it is observed and accepted that naturally occuring age-related loss of near vision has emotional repercussions, how it is that the LASIK industry can deny that visual difficulties from LASIK has emotional repercussions???

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Oftalmologia. 2008;52(2):103-7.
[Presbyopia--the last major challenge in ocular surgery][Article in Romanian]

Potop V.
Univ. UMF Carol Davila, Bucureşti.

Presbyopia is the natural loss of accommodation that affects the majority of middle-aged individuals. Once a person reaches their mid 40s, has trouble making activities that were easily performed when younger such as reading, using a cellular phone or computer. In addition to the visual difficulties emotional repercussions have been observed. The mechanism of presbyopia is not completely understood but it has many treatments from monovision and refractive surgery to scleral expansion surgery or PreLEX. Presbyopia represents one of the major challenges facing ophthalmology today.