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Dr. Jose Lamarca, an ophthalmologist at the Barraquer Ophthalmology Centre, has once again taken the mic for our podcast Decansa la vista to explain what presbyopia consists of and review all the therapeutic options that patients can benefit from. He explains it in the special episode Presbyopia #6.
What is presbyopia?
Presbyopia is the gradual loss of the ability to focus on up-close objects. It appears physiologically in all people from the age of 40, approximately, when the natural lens of the eye, the crystalline lens, begins to lose its natural elasticity, making it difficult to accommodate vision.
“Absolutely all of us will suffer from presbyopia, to a greater or lesser extent, depending on their prescription. Myopes usually develop it later, while patients with hyperopia can start earlier”, explains Lamarca. Although it is absolutely normal and poses no risk, the progression of presbyopia is often uncomfortable and can reduce the quality of life of patients.
Therapeutic options for presbyopia
Treatment for presbyopia is very personalized. It requires an exhaustive study to select the most appropriate therapy for each person, since we currently have a large number of options:
- Progressive glasses.
- Progressive contact lenses.
- Laser techniques.
- Surgery with implantation of a phakic intraocular lens (outside the crystalline lens).
- Clear lens surgery, popularly known as presbyopia surgery or premature cataract surgery. In this option, an intraocular lens is implanted inside the crystaline lens and the appearance of a future cataract is prevented.
Why not perform surgery on both eyes at the same time?
When we perform surgery, in addition to carrying out an exhaustive preoperative procedure and working with the widest range of lenses to offer maximum customization, Barraquer offers other differential points that reduce risk and optimize results: "We operate presbyopia on both eyes separately because we don't want any surprises”, says Dr. Lamarca.
"If there is slight error in the first intervention, we have room to make modifications before the second"
As the specialist has clarified, it is true that undergoing surgery of both eyes at the same time with drop anaesthesia can be attractive since it requires less surgical investment and shortens the postoperative period. But this option has important disadvantages because operating on both eyes at the same time does not allow for error and, furthermore, drop anaesthesia requires the collaboration of the patient during surgery, who has to look at a light and try to be still with one eye that it is not completely locked.
On the other hand, the team to which Dr. Lamarca belongs, after operating on the first eye, can check that the lens placed is the right one before proceeding with the second eye: "It doesn't usually happen, but if there is a slight error, we have room to make modifications before the second surgery”. In addition, as another differentiating element, the anaesthesia used leaves the ocular structure totally blocked: "We are very respectful in relation to analgesia and prefer to use local anaesthesia and not topical, although it requires a higher cost and surgical structure due to the mandatory presence of an anaesthetist during surgery. Only in this way can we provide greater comfort and a much more relaxed experience to the patient, who will not feel pain and will not have to collaborate during the intervention," adds the doctor.