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Visual symptoms in older people may derive from presbyopia and dry eye (DE) with sex-specific pathology. Previous studies have suggested women may have a greater risk for presbyopia than men of the same age. However, the association between DE, which is more frequent in women, and presbyopia has not been determined. This study explored whether the relationship between DE and the severity of presbyopia differs by sex. This cross-sectional retrospective cohort study included 1147 bilateral phakic patients, aged from 40 to 55 years (858 women and 289 men). Refraction, near add power at 30 cm, and DE-related clinical parameters (corneal staining score and tear break-up time [BUT]) were compared between the sexes. Correlation analyses and odds ratio comparisons of risk factors for reaching specific near add power (1.00, 1.25, 1.50, and 1.75 D) were performed. Corneal staining and tear break-up time (BUT) were worse in women. Correlation analysis stratified by sex revealed that near add power correlated with age (women: β = 0.80, P < 0.01; men: β = 0.80, P < 0.01), and astigmatic errors (women: β = 0.16, P < 0.01; men: β = 0.19, P < 0.01) in both sexes, BUT only in women (β = -0.10, P < 0.01), and corneal staining only in men (β = 0.20, P < 0.01). Women with short BUT and men with corneal staining were more likely to reach higher near add power. The current study suggests that men with corneal staining and women with short BUT may need more near add power. These DE-related clinical features are significant factors for presbyopia and should be managed to ameliorate presbyopia-related symptoms.

This study was undertaken to evaluate the safety and efficacy of CSF-1 (0.4% pilocarpine hydrochloride ophthalmic solution) for use in individuals with presbyopia. Two Phase 3 multicenter, randomized, double-masked, vehicle-controlled, parallel-group clinical trials were conducted in 35 private ophthalmology clinics in the United States from October 2020 to February 2022. Key inclusion criteria were the following: (1) age 45–64 years, (2) distance-corrected near visual acuity (DCNVA) at 40 cm ≥0.40 and ≤0.90 logarithm of the minimum angle of resolution (logMAR, approximately 20/50–20/160 Snellen) in at least 1 eye, (3) manifest refraction (MR) between –4.50 and +2.00 diopter (D) sphere in each eye with ≤2.00D difference between eyes, (4) <2.00D of cylinder MR in each eye, (5) ≤0.04 logMAR (20/20–2 or better) corrected distance visual acuity (CDVA) at 4 m in each eye. Key exclusion criteria were the following: (1) >0.14 logMAR (7 letters) improvement in post-vehicle treatment in monocular DCNVA in either eye at visit 1, (2) introcular pressure (IOP) <9 or >22 mm Hg, (3) average dark-adapted pupillometry <3.5 mm in either eye, (4) prior refractive surgery or intraocular lens (IOL) implantation. Participants applied CSF-1 or vehicle twice per day for 2 weeks. Efficacy and safety assessments were performed at several times on days 1, 8, and 15. Response was defined as ≥3-line gain in DCNVA without loss of ≥1-line in CDVA in the study eye under mesopic room lighting conditions. The primary efficacy endpoint was measured 1 hour post-dose 1 on day 8. Key secondary endpoints were 2 hours post-dose 1, and 1 and 2 hours post-dose 2, also on day 8. Safety endpoints were ocular and non-ocular treatment-related adverse events (TRAE), conjunctival redness, drop comfort, slit-lamp biomicroscopy, intraocular pressure, indirect fundoscopy, and CDVA at 4 m. Six hundred thirteen participants were randomized to CSF-1 (n = 309) or vehicle (n = 304). Participants were predominantly White (80.8%) and female (62.0%), with mean age (standard deviation) of 54.7 (4.8). CSF-1 met the primary and key secondary endpoints. At the primary endpoint, 40.1% of the CSF-1 group achieved response versus 19.1% of the vehicle group (P < 0.0001). The percentage of responders was significantly greater in CSF-1 compared with vehicle at all tested times. Changes from baseline in all safety endpoints were comparable between groups. Most adverse events (AEs) were mild and transient. Neither serious nor severe AEs were reported with CSF-1. CSF-1, a low-dose pilocarpine ophthalmic solution, demonstrated superiority to vehicle in improving near vision in individuals with presbyopia without compromising distance vision. CSF-1 demonstrated a favorable safety profile. ClinicalTrials.gov identifier: NCT04599933 (NEAR-1), NCT04599972 (NEAR-2).

Objective To evaluate changes in choroidal thickness in presbyopes, when reading with regular glasses versus choroidal control glasses, in patients with or without Age-Related Macular Degeneration (AMD). Methods This was a pilot study on short-term axial length (AL) in 33 eyes of 24 presbyopic patients aged 60 to 80 years, assigned to two age-matched groups, with or without AMD. About them, changes in choroidal thickness were evaluated with ocular biometry through indirect measurements of axial length at baseline, after 20' of reading with conventional lenses, and after another 20' of reading with peripheral hyperopic defocus glasses. The differences in axial length between the three different times were analyzed. Results In presbyopes without AMD there was a significant axial length shortening of -13.44 microns in the first conventional reading period, which was reversed by 90% with hyperopic defocus lenses, recovering + 12.11 microns by axial lengthening (choroidal thinning, p  = 0.03). In patients with AMD, axial shortening was significantly greater than controls, -23.86 microns with conventional lenses ( p  < 0.001) and they, also increased their axial length with defocus, although this response was smaller in proportion (+ 15.52 microns). Conclusion Reading with positive lenses produces myopic defocus and choroidal thickening in presbyopes with and without AMD but was significantly greater in the latter. Glasses with Choroidal Control Technology reduced thickening during reading. Key messages What is known • Presbyopia spectacles for near produce myopic defocus and choroidal thickening. What is new • There are differences in choroidal thickening during reading between normal subjects and those with age related macular degeneration. • Spectacles with Defocus Choroidal Control Technology reduce choroidal thickening during reading in presbyopes.

Purpose To analyze the difference in objective and subjective photic phenomena following virtual implantation of three different presbyopia-correcting diffractive intraocular lens (IOL) designs. Methods The study was conducted at JENVIS Research Germany. A prospective cross-over and double-masked trial design was used. Seventy-four healthy individuals without cataract (age: 18 to 50 years) were enrolled. All participants assessed photic phenomena with three diffractive IOL designs by virtual implantation using the VirtIOL device (10Lens S.L.U), which allows participants to view through the IOL imaged at the iris plane as if it were implanted: IOL A (Tecnis Synergy ZFR00V; J&J Vision), IOL B (AcrySof IQ PanOptix TFNT00; Alcon Laboratories, Inc), and IOL C (AT ELANA 841P; Carl Zeiss Meditec). The size of the starburst and annular light pattern was measured in degrees, and participants were asked about their preference in terms of quality of night vision when comparing by pairs the IOLs. Results The starburst pattern size was significantly larger with IOL A (5.54 ± 0.62º) compared to the IOLs B (3.82 ± 0.90º, P < .001) and C (3.65 ± 0.57º, P < .001). However, there were no significant differences between IOLs B and C (P = .078). Regarding the induced annular light pattern, no significant differences were found between IOLs (P > .05). In a pairwise short-term comparison of the IOLs using a simulated night scene with a glare source, participant preference was in favor of IOL C (P < .001). Conclusions IOL A had objectively a significantly larger starburst pattern than the other two. In a short-term comparison, the new trifocal IOL C was significantly preferred in a night driving scene.

This is an overview of systematic reviews to evaluate the visual outcomes of different presbyopia correcting intraocular lens (IOL), spectacle independence (SI), adverse visual effects and cost-effectiveness. Reviews were included if they compared presbyopia-correcting IOLs—such as multifocal (bifocal and trifocal), extended-depth-of-focus (EDOF), and accommodative and monofocal IOLs. The AMSTAR-2 tool was used. Primary outcomes were uncorrected distance visual acuity (UDVA), intermediate visual acuity (UIVA) and near visual acuity (UNVA). Secondary outcomes were SI, halos and glare, and cost-effectiveness. Prospero registration CRD42023425283. Eight systematic reviews were included. None scored ‘Yes’ in all AMSTAR-2 tool 16 items. Primary outcomes were as follows: all IOLs reported similar UDVA. EDOF and trifocal IOLs reported better UCIVA. Trifocal diffractive, EDOF, accommodative and bifocals were better than monofocal IOL for UNVA and of these trifocal and biofocal reported better UNVA. Secondary outcomes: SI was better with trifocal, bifocals and EDOF compared with monofocal IOLs. Trifocals and bifocals reported more glare and halos. No review reported cost-effectiveness. The findings indicate that while multifocal and EDOF IOLs show comparable performance in UDVA and UIVA, multifocal performs better in UNVA but at the cost of glare and halos. EDOFs may offer superior spectacle independence but may not consistently match multifocal in near vision.

BackgroundA pilot eyecare programme aimed to address the urgent eye health needs of older Zanzibari craftswomen. We investigated the impact of correcting presbyopia on their subjective well-being (SWB) 6 months post-correction and assessed the cost-effectiveness of a women-targeted presbyopia correction programme.MethodsThis study involved Zanzibari craftswomen aged 40 and older with presenting and corrected distance visual acuity better than 6/12 in both eyes and were presbyopic. Using a before–after method, we assessed SWB on a 10-point scale before and after providing free spectacles. Mean SWB scores and differences pre-correction and post-correction were calculated. Programme costs were analysed to determine the cost per SWB score gained and the monthly cost for each SWB score improvement. Additionally, scenario analysis estimated costs for 12 approaches.ResultsOf 282 craftswomen, 209 met the eligibility criteria. SWB scores significantly increased from 3.34 to 8.14 post correction (p<0.001). Screening costs totalled US$12 885.84, with an average cost of US$45.69 per craftswoman screened and US$61.66 per presbyopia identification. The total programme cost was US$14,574.69. One hundred fifty-four craftswomen experienced increased SWB, with a total of 747 score gains. Achieving one SWB score improvement cost an average of US$19.50, with a monthly average cost of US$3.40 per improvement. Utilising woman screeners, organised transport and ready-made spectacles appeared to be the most cost-effective approach.ConclusionCorrecting presbyopia through a targeted eyecare programme significantly enhanced SWB among craftswomen. While the programme seems cost-effective, further research is warranted to explore long-term economic benefits and definitively assess cost-effectiveness in larger studies.

Near-vision is important for employees to reach better performance. The prevalence of uncorrected presbyopia ranges from less than 10–90% according to various sociodemographic factors including age, sex, educational level, affordability, and awareness. Current study aims to determine the prevalence of spectacle coverage for presbyopia correction and its associated factors among adult employees of a university. A cross-sectional study was conducted on Tehran University of Medical Sciences’ staffs aged ≥ 30 years in 2018–2019. All participants were assessed for distance and near visual acuities. Presbyopia was defined as inability to read 20/50 (N8) at 35 cm despite of corrected distance VA of at least 20/50 in the better eye. Total spectacle coverage for presbyopia was calculated as the number of participants with current near vision spectacle ⁄ number of participants with presbyopia. If persons with presbyopia had spectacles that allowed near vision to improve to 20/50 (N8) or better, it was true near spectacle coverage. Included was 4022 participants with mean (standard deviation) age of years 43.61 (7.92) years (range: 30–75 years). The prevalence of presbyopia was found to be 12.6% (507/4022). The total and true spectacle coverage for presbyopia correction were 35.9% (182/507) and 22.7% (115/507), respectively. Female (OR = 4.89, 95%CI = 1.82–13.18, P  = 0.002), age ≥ 45 years (OR = 18.69, 95%CI = 1.69-206.18, P  = 0.02), hyperopic refractive error (OR = 5.61, 95%CI = 1.75–17.93, P  = 0.004), and poor to fair level of general health (OR = 2.94, 95%CI = 1.16–7.69, P  = 0.02) were factors significantly associated with the total spectacle coverage. Academic educational level (OR = 2.76, 95%CI = 1.03–7.45, P  = 0.04) and poor to fair general health (OR = 3.45, 95%CI = 1.41–8.33, P  = 0.007) affected the true spectacle coverage. Nearly one-third of employees with presbyopia used spectacle for near vision, among whom 63% had true near spectacle. Near spectacle use was higher in elderly females with hyperopia and poor to fair general health. People with academic educational level and poor-fair general health wore true near spectacle.

Background and Objectives: This study aimed to illustrate a novel method for improving presbyopia by drinking cassiae tea. Materials and Methods: A total of 425 eyes from 425 participants (aged 52.5 ± 9.5 years) were recruited and divided into several experimental groups over a 6-month period. Participants consumed cassiae tea daily (10 g of cassiae semen brewed in 500 cc of water). Meanwhile, control group participants consumed 500 cc of plain water along with 1000 mg of vitamin C each day. Experiments 1 and 2: Participants with severe dry eye and intraocular pressure (IOP) > 30 mmHg were enrolled, and outcomes were assessed for these conditions, respectively. Experiments 3, 4, and 7: These experiments evaluated pupil size, near vision, and serum superoxide dismutase (SOD) levels in two groups of volunteers. Experiment 5: Different quantities of cassiae tea were prescribed to various groups, and near vision was measured. Experiment 6: Three questionnaires assessed presbyopic symptoms after cassiae tea consumption. Experiment 8: The antioxidant activity of cassiae tea compared with other bioactive compounds and Chinese herbs was evaluated using the DPPH test. Results: By the fourth month of the study, participants experienced increased tear volume and reduced IOP. Pupil size constricted, near vision improved, and serum SOD levels increased. Furthermore, greater consumption of cassiae tea was correlated with better near vision. The antioxidant activity of cassiae tea was found to surpass that of anthocyanins, wolfberry, and vitamin C. Conclusions: Drinking cassiae tea improves dry eye symptoms, reduces IOP, regulates pupil size, and enhances near vision due to its excellent antioxidant and pharmacological properties. These benefits may particularly aid individuals with presbyopia and those engaged in near-distance activities, such as smartphone use.