Presbiopia, a condition that sooner or later must be dealt with after the age of 40. The word derives from ancient Greek, from the union of two terms: “presbys” which means old and “opia” sight, eye. According to an Ac Nielsen analysis commissioned by CDV Vista Onlus Defense Commissionpresbyopia concerns the 41% of Italians over 40, with peaks of over 53% for those over fifty. It is estimated that it involves well in the world 2 billion people. But today there are many solutions, in addition to glasses. We talked about it with Doctor Tommaso Nuzzo, ophthalmologist and medical director at San Paolo hospital in Milan.
Presbyopia, myopia and other visual defects: when laser is needed
Myopia, astigmatism and hyperopia can be treated with refractive surgery with excimer lasera safe and effective surgical technique now also used in Italy since the 90s. The laser is in fact capable of removing microscopic parts on the surface of the cornea with extreme precision and is used to “reshape” its curvature. In this way it is possible to eliminate or reduce the refractive defects, i.e. visual pathologies that prevent objects from being able to focus correctly and therefore require the use of glasses or contact lenses. But how does it work? Is it possible to use laser even after the age of 40, perhaps to correct presbyopia?
Why does vision start to get worse after age 40?
Doctor Tommaso Nuzzo, ophthalmologist and medical director at the San Paolo hospital in Milan.
«In a healthy patient without previous visual disturbances, after the age of 42/45 the ciliary muscle of the lens begins to lose elasticity And difficulty accommodating up close. At a distance of 30/40 cm it doesn’t focus well because loses accommodative elasticity. Often the situation worsens around the age of 58/60″, explains Doctor Nuzzo. You then start using near glasses, but it is often difficult to get used to this new type of vision and you change several glasses before finding the right one. «Generally, it is better not to start wearing glasses right away because the “training” of the ciliary muscle of the lens is lost, which becomes lazy”, recommends the expert.
What is presbyopia, when and how does it appear
«Presbyopia is a near refractive errorand is expressed with the visual difficulty reading and writing at a distance of 30/40 cm. It generally occurs around the age of 42/45. If there is a history of myopia and astigmatism the situation can change. For example, if you are short-sighted, myopia compensates for presbyopia, i.e. the defect of myopia is corrected with a negative lens and presbyopia with a positive lens. So basically If you are already nearsighted, once presbyopia begins you will naturally begin to see better. L’Astigmatism, on the other hand, also involves blurring up close, therefore with the advent of presbyopia things get worse”, specifies Doctor Nuzzo.
Can laser solve presbyopia?
«To date, the excimer laser does not solve it, it is instead used to correct myopia, astigmatism and hyperopia. But for presbyopia there is a procedure, called Supracor which is performed on some patients selected based on their characteristics and the possibility of success of the technique. In some patients, even young ones, the lens becomes opaque early at 40/45 years of age. There may therefore be a beginning of cataract, for which it is possible to correct with replacement of the lens, including presbyopia. It is therefore not a refractive laser surgery operation, but ocular microsurgery. Some patients with significant refractive errors replace the lens even before they develop cataracts”, adds the expert.
What tests are needed before laser surgery
There are some assessments that must be done before undergoing refractive surgery. «It is essential to carry out an accurate pre-operative evaluation. The required exams are the Corneal topographybecause the cornea is treated by the laser and therefore its starting condition must be examined, the PupillometryL’ OCT of the anterior segment. The cataract surgery went through the National Health System”, adds Doctor Nuzzo.
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