Multiple Presbyopic Corrections Across Multiple Centuries

Last month, Optometry and Vision Science led with an interesting publication showing that orthokeratology can be applied to steepen the cornea and make an eye myopic1 as opposed to the usual use of orthokeratology to reduce myopia. Why do that? Well, it is a new way to produce monovision for the correction of presbyopia. Obviously, it is quite similar, in concept, to producing monovision in presbyopes by fitting a plus contact lens to one eye in an emmetropic patient and creating clear distance vision in one eye and clear near vision in the other. And also, like the quite common fitting and removing of a plus contact lens, the corneal reshaping itself is reversible, typically within a week. All of the issues of monovision and its impact on binocular vision and depth perception are probably the same with this new approach. Our authors were able to produce about 1.25 diopters (D) of increased plus power (most in the first day of orthokeratology that they applied for a week of overnight wear) for their 50-year-olds (aged 43 to 59 years) and managed to provide surprisingly good vision. Issues clearly remain, including how to gain more than 1.25 D, and clearly identifying the actual changes in the cornea. Our authors call for larger refractive manipulations and longer duration studies. Not surprisingly, the media release produced by our publisher captured public attention. The media release and the open access article are available in the April 2013 issue at the website (www.optvissci.com) as part of the Table of Contents. There can be little doubt that the attempts to address presbyopic loss of near vision are center stage for many ophthalmic surgeons, optometrists, contact lens companies, and spectacle lens manufacturers. The “ideal” solution is clearly worth billions of dollars, and the numerous demonstrated corrections or therapies are already a huge part of the ophthalmic economic world. Corneal refractive surgery itself has inspired many efforts to create not only monovision but, occasionally, multifocal vision. And the successful 1949 introduction of intraocular lenses (IOLs) soon after World War II (by Sir Harold Ridley at London’s St. Thomas Hospital) has led more recently to efforts to correct presbyopia with a monovision and a multifocal IOL surgical solution. Multifocal IOLs are a more recent pursuit, and they are being developed with the same challenges that come with a multifocal contact lens. Optometry and Vision Science has published numerous studies during the past 4 to 5 years, some in the past few months, where vision with multifocal contact lenses is compared with monovision with various, and sometimes conflicting, results.Plaque at the St. Thomas Hospital, London. First permanent insertion of an intraocular lens, February 8, 1950. From Wikimedia Commons.Of course, single-vision reading glasses use has a very long history indeed! Benjamin Franklin, who was reported to have invented bifocals more than 250 years ago (or, at least, he was among the first to wear bifocals), could probably not imagine that so many different solutions to presbyopia would be so actively pursued 250 years later. Nor could John Isaac Hawkins’ invention of trifocals in the early 19th century or Owen Aves’ patenting of progressive addition lenses (although never commercialized by him) in the early 20th century, have imagined the “hot pursuit” for presbyopia treatments being witnessed today. Quite possibly, the introduction of the seamless bifocal in 1955 by Irving Rips of Younger Optics was a precursor to all progressive lenses, although it was the development by Bernard Maitenaz, and a patent in 1953, that likely led to the pioneering of modern design progressive addition lenses, soon after, by Carl Zeiss and Varilux.Portrait of Benjamin Franklin (1706–1790) by Joseph Siffred Duplessis. From Wikimedia Commons.Regardless of any arguably appropriate crediting of each of these developments, suffice it to say that the extent of creative applications for the correction or elimination of presbyopia in research and commercial enterprises is enormous. We thought that our readers, and the public, might be interested in yet another approach being validated—at least for the early stages of presbyopia where 1.25 D assistance at near is clearly useful and achievable via what is known as hyperopic orthokeratology. In this case, it is making an emmetropic eye myopic for the purpose of reading. No doubt the “alchemy” and search for the ultimate presbyopia solution will continue. Tony Adams Editor in Chief Optometry and Vision Science