Surgical Correction of Presbyopia - The Fifth Wave

Wang Vision 3D Cataract & LASIK Center, Nashville, Tennessee

Forty percent of the world’s population is presbyopic. The focus of the book “Surgical Correction of Presbyopia: The Fifth Wave” is detailed presentation and discussion of the techniques that have recently become available or are under active clinical investigation for surgical correction of presbyopia.  Presbyopia is the “holy grail” or “the last frontier” of ophthalmology, which we refer to in this book as the “Fifth Wave” of refractive and lens surgery.
            We have come a long way in our understanding of the mechanism of presbyopia. Through the late 1800s and 1900s the accepted theory of accommodation was that of Hermann von Helmholtz, a German physiologist, who, in 1865 proposed that accommodation occurred because the lens, pulled on by zonules, became thickened in the center, producing greater magnification. His friend, Franz Cornelius Donders, supported his theory in his classic textbook Accommodation and Refraction of the Eye published in 1884.  Because of this endorsement no one challenged the Helmholtz theory for many years.
            In 1924, an ophthalmologist, Dr. Lindsay Johnson, of Durban, South Africa published a challenge to Helmholtz in the June, 1924 issue of Annals of Ophthalmology. Johnson theorized (as others had in the past) that on accommodation the lens, being pulled on by zonules, and pushed by vitreous, moved forward in the eye, producing magnification and near focus.
            In the 1970s and 80s, brilliant experiments by Dr. Jackson Coleman of New York demonstrated that the vitreous, pulled forward by zonules on accommodation, pushed the lens forward. Many scientific studies have confirmed the forward movement of the lens on accommodation, and efforts have been aimed at providing the means for this to occur.
            Today, we have now a wide variety of treatment available for presbyopia. The surgical treatments for presbyopia discussed in this book include corneal solutions including laser treatments and corneal inlays, lenticular solutions including intraocular lenses, and scleral solutions such as scleral implants and ablation. The indications, benefits, results and risks of these procedures are discussed with close attention to clinical applications. Chapters on complex cases will focus on improving outcomes both with patient and surgical modality selection and post-operative management.
            Marketing to the presbyopes, particularly plano presbyopes, to whom eyecare professionals such as ophthalmologists and optometrists have traditionally no influence since these patients typically do not see eye doctor, presents a unique and new challenge. We will discuss some innovative ideas in this area.
            This will be the first such comprehensive review of all of the state-of-the-art surgical treatments for presbyopia, including not only those that are currently available but also those under active clinical investigation. The target audience of the book is ophthalmology students, practicing ophthalmologists, optometrists, and ophthalmology technicians and opticians. Presbyopia is the most common refractive condition and more patients and providers are now actively seeking surgical solutions. This book has potential to reach a significant and wide audience and become a must-have desktop reference for eyecare professionals.

Ming Wang, MD, PhD,
Editor, “Surgical Correction of Presbyopia: The Fifth Wave”
Clinical Associate Professor of Ophthalmology
Department of Ophthalmology, University of Tennessee
Nashville, TN, USA

Spencer P. Thornton, MD, FACS
Past president, American Society of Cataract and Refractive Surgery
Clinical Professor, Department of Ophthalmology
Department of Ophthalmology, University of Tennessee
Nashville, TN, USA