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Thread: Correction of presbyopia

  1. #1

    Default Correction of presbyopia

    By Prof. Dr.Gehad Elnahri
    Correction of presbyopia; revision

    While practicing last Monday, i asked a resident to prescribe reading glasses for a 50 year female who never wore glasses before
    Her autoref readings where +3.0/-1.5 x 90
    He prescribed
    +5.0/-1.5 x 90 OU with acuity 6/6, this is VERY wrong (it seems he did not read my posts , i like learning by repetition so let's repeat
    1)do NOT prescribe cylinders for the first time above 40
    2)i view of this we re-calculate the refraction as +2.0 SE OU
    3)based on the power of accommodation at 50, distance correction is +1.0
    4)NEVER increase reading glasses by more than 1.0 at a time
    5)the final reading prescrition for this lady is +2.0 OU which can be bought ready made at the pharmacy
    It would be a shame for our practice that a patient finds that ready-made eye-glasses she bought from a cheap stand WAY more comfortable than our prescribed ones.
    Please know how to prescribe GOOD glasses or surrender the job to optometrists.
    Correction presbyopia attachment.php?attachmentid=3150&d=1496405455

    By Dr.
    Mona HussienCan you please explain point 2 ?

    By Dr.
    Gehad Elnahri3.0 S, -1.5 C Spherical equivalent SE +3.0 -0.75 (-1.5/2)= 2.25

    By Dr.
    Ahmed Moustafa Abdel AzizSo now , can you explain point 3?

    By Dr.
    Gehad ElnahriAt age 50 there are 2D of accommodation, we leave the patient use 1/2 his accommodation and correct half, so he corrects 1D of his error and we prescribe 1D for distance

    By Dr.
    Ahmed Moustafa Abdel AzizThat's what I was asking about, why only 1D for distance while the patient has 2D of hypermetropic, and the magnitude of accommodation is declining. Isn't it better to prescribe 2D or so for distance? Then wasn't the rule before to leave the patient use only 1/3 of his/her accommodation?
    Thanks for your patience in front of my silly questionsCorrection presbyopia 1f60a.png

    By Dr.
    Gehad ElnahriNo big differences, if u make her use 0.75 D then prescribe 1.25 for distance, then add 0.75D as max near-add then total is 2.0D
    Another advantage of the 2.0 D prescription is by time the patient will find that it is good for distance vision and start to use it in TV, then i give another add for reading
    I never exceed max distance correction in FIRST glasses

    By Dr.
    Nawar Khan SharifIf u do not mind , can u explian me the chart for presbyopia correction according to the age
    Shortly if u have time ?

    By Dr.
    Gehad ElnahriPresbyopia around 45
    From 45-48 approx +1.0 to distance correction
    48-50 needs +1.5

    50 + needs 2.0-3.0 according to working distance
    This is for emmetropes
    Now problems arise if a hypermetrope becomes presbyope and never wore glasses. This is the one we are discussing above

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