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PRESBYOPIA

Presbyopia literally means ‘old sight’. When we read or look at something close, the flexible lens inside the eye changes shape to provide the close focus required. However, as we age, the lens becomes less flexible and its ability to change shape is reduced.

Presbyopia Program

This inevitable loss of flexibility to the lens inside our eye as we age is called 'presbyopia' and causes near vision to be blurred.
  • Presbyopia is a natural part of ageing and a gradual process that usually begins at around 40 years of age. As a result, almost everyone over the age of 45 needs vision correction for reading and other close work.
  • Presbyopia is the most widespread ocular problem in the world. There are currently over 1 billion people with presbyopia.1
  • In 2010, approximately 44% of the Australian population were in the presbyopic age bracket (almost 10 million people).1
  • Presbyopia can be corrected with reading spectacles, bifocal or multifocal spectacles, and contact lenses.

Research Projects

Multifocal contact lenses
Many commercial multifocal lenses claim to provide simultaneous vision at various visual distances but often this comes at the cost of reduced contrast, increased ghosting (a blurred, shadow-like effect), haloes (rings around bright points of light) and compromised overall vision satisfaction.

These shortcomings are often exacerbated with low illumination levels. Such visual compromises have been associated with an increase in patient dropout rate and lack of confidence in fitting by practitioners.

We are currently developing a range of extended depth of focus (EDOF) contact lenses, which are designed to provide optimal visual performance from distance to near with minimal ghosting. The range of EDOF designs aim to deliver a vision solution for all presbyopes including emerging, early, medium and mature presbyopes.

Our EDOF contact lenses, using patented technology:
  • use higher order aberrations to optimise retinal image quality over a wide range of distances from far to near while eliminating ghosting and haloes;
  • perform relatively independent of patients natural aberrations and variation in pupil size; and
  • are designed to meet the vision needs of emerging, moderate and advanced presbyopes.
Multifocal intraocular lenses
Intraocular lenses (IOLs) are inserted after surgery for removal of cataract, usually providing patients with good distance vision but leaving them needing reading glasses to achieve good near vision. Multifocal IOLs seek to provide acceptable vision at multiple distances, from near to far.

We are now developing an IOL that incorporates EDOF principles to achieve good vision at all distances.
Accommodating Gel
There is currently no successful therapeutic, surgical treatment or cure for reversing presbyopia. Currently marketed technologies don’t restore the eye’s natural ability to focus.

The Accommodating Gel is a clear gel-lens system that will replace the eye’s natural lens when it loses its ability to change power. The lens is removed during a procedure similar to that used for conventional cataract surgery and replaced by the polymer gel-lens. The major advantage of the Accommodating Gel technology is its unmatched ability to comfortably meet accommodation requirements for reading; ; providing correct focus at any distance just like the natural young lens.

The Accommodating Gel technology would be initially marketed as an alternative to conventional intraocular lens (IOL) replacement in cataract surgery procedures, wherein the opaque lens is removed and replaced by a synthetic IOL. The Accommodating Gel technology is available for co-development or licensing to commercial.

PublIc Health Strategies

Public health research
We undertake studies to generate an accurate picture of vision impairment within defined areas and amongst specific demographics. We also conduct research to evaluate the effectiveness of our programs, which feeds into subsequent designs. These studies help inform strategies for human resources and infrastructure development to establish sustainable eye care services.

In 2009, a landmark study revealed that 517 million people (mostly in developing communities) have inadequate correction for functional presbyopia.1 By quantifying the vast need for eye care services it provided evidence to support advocacy efforts with government and funding bodies, as well as planning for services.

In the same year, research by Brien Holden Vision Institute and partners, revealed the global economic cost in lost productivity due to uncorrected refractive error (URE) alone was a staggering US$202* billion each year2,3 (this did not include uncorrected presbyopia). It has since been estimated that a one-off investment of US$28 billion would be sufficient to establish and operate the educational and refractive care facilities required to deal with vision impairment resulting from URE.3

Such an investment would result in health, education, economic and quality of life benefits for individuals and a significant saving to the global economy.3

Find out more about our public health research.

*The original study estimated the loss in productivity in International Dollars. This was converted into U.S. Dollars in the subsequent study by Fricke and colleagues (2012).
Sustainable eye care services
An estimated 625 million people are blind or vision impaired globally because they do not have access to an eye examination and appropriate glasses.1,4 An estimated 517 million of that is due to uncorrected presbyopia.1

This is largely due to a lack of facilities, infrastructure and the equipment necessary to provide eye care services, as well as a shortage of practitioners and other skilled personnel, especially in rural and remote areas in developing communities.

Our strategy to develop sustainable eye care services is based on the establishment of environments that enable trained eye care professional to provide much needed services locally.

Find out more about our public health programs.

References

  1. Holden BA, Fricke TR, May Ho S, Wong R, Schlenther G, Cronjé S, Burnett A, Papas E, Naidoo KS, Frick KD, ‘Global vision impairment due to uncorrected presbyopia’, Archives of Ophthalmology, Vol 126 (No. 12), Dec 2008.
  2. TST Smith, KD Frick, BA Holden, TR Fricke & KS Naidoo, Potential lost productivity resulting from the global burden of uncorrected refractive error, Bulletin of the World Health Organization 2009;87:431-437.
  3. Fricke TR, Holden BA, Wilson DA, Schlenther G, Naidoo KS, Resnikoff S & Frick KD. ‘Global cost of correcting vision impairment from uncorrected refractive error’, Bulletin of the World Health Organization, 2012; 90:728-738.
  4. Bourne RR, Stevens GA, White RA, Smith JL, Flaxman SR, Price H, et al. Causes of vision loss worldwide, 1990-2010: a systematic analysis. The Lancet Global Health. 13 November 2013.