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Up Front | Jan 2009

Celebrating Innovation in the Year of Presbyopic Correction

Happy New Year to our readers, from the editorial board and staff of CRST Europe! Let us optimistically hope that the issues affecting the world have minimal impact on our own work and practice.

The interest in presbyopia correction has been predictable for a couple of reasons, and we are fortunate enough to have the means to offer our patients phenomenal reliability of myopia, hyperopia, and astigmatism correction. Presbyopia is the remaining, and the next, frontier. A major driver in our quest to find the best presbyopia correction technique is the advancing aging population. As baby boomers age, they are looking for more than just getting out of distance glasses. In the United States, the number of 75-year-olds has doubled in the last 20 years, and we have not yet even reached the edge of the boomer bump.

Advancing interest in presbyopia has led to a flurry of innovation, as evidenced in this issue and the establishment of an avenue for exchange of ideas: the International Society of Presbyopia. Although established in 2005, the society had only its second, but very popular, meeting in September 2008. Michael Mrochen, MD, PhD, the society secretary, provides more information along with plans for a future meeting in his cover article.

Further innovation is to be celebrated. No one yet knows what will be the dominant method of presbyopia correction in the future. Certain principles seem to withstand the test of time—simplicity, rapid recovery, reliability, stability, and in some instances, reversibility, are important. A variety of concepts, all fairly investigational and at varying levels of development, are reported in this month's cover focus. Some excellent clinical data is presented, and it will be reassuring to not only see this repeated by other investigators but substantiated by basic scientific evaluations. How often have we seen a flurry of excitement about a technique, only for it to be forgotten again a few years later.

As several authors have correctly addressed, in many presbyopic corrective techniques, there is a level of compromise—whether it be two focal points from multifocal lenses, or partial monocular blur from monovision, there is a need in many instances for cortical adaptation. We must not forget about our patients and their expectations in the process. Careful patient selection, counseling, and sometimes more hand-holding postoperatively are necessary for success. One issue that remains a concern is the future for those patients undergoing presbyopic correction now; cataracts will occur, resulting in alteration of contrast sensitivity as well as possibly refractive change. In my own experience, these patients are demanding and expect earlier correction. This, I must confess, alters my personal patient selection process considerably. Presently, those patients advancing in years to their fifth decade will often receive a lens exchange procedure with either an accommodating or multifocal lens. Who knows, this might well be considered primitive 5 years from now, with advent of more clever technologies, such as femtosecond lentotomy.

We hope you enjoy this first issue of 2009—which I am inclined to call The Year of Presbyopic Correction. Again, please do not hesitate to send us your letters or e-mails supporting or challenging the contents of this and previous issues.