Acta Ophthalmologica 2014 Review Article Review of the impact of presbyopia on quality of life in the developing and developed world Ariana D. Goertz,1 William C. Stewart,2 William R. Burns,3 Jeanette A. Stewart2 and Lindsay A. Nelson2 1University of Nevada, Las Vegas, Nevada, USA 2PRN Pharmaceutical Research Network, LLC, Cheyenne, Wyoming, USA 3Encore Vision, Inc., Fort Worth, Texas, USA ABSTRACT. (Barbero 2013). Everyone eventually Purpose: To examine the public health impact of presbyopia regarding its effect develops presbyopia but symptoms on quality of life (QoL) and society in both the developed and developing worlds. may vary. The major risk factor for Methods: A database was created from articles found on PubMed, the Cochrane presbyopia is age although the condi- Library and Science Direct using the following search terms: presbyopia, QoL, tion may be affected by other factors accommodation, impact, cost, prevention, treatment and public health. Articles including disease, trauma and medica- were accepted into the database if they addressed presbyopia and public health. tions (American Optometric Associa- Results: This study showed in the developed world presbyopic subjects treated tion 2010). with reading glasses suffered a reduction in QoL parameters compared with Presbyopia is classically believed to those who were younger and emmetropic. A small minority of subjects were result from hardening of the lens although other causes have been assessed to be a candidate for additional non-spectacle treatment measures. In described as well such as changes in undeveloped areas, the manifestations of presbyopia were similar to the tissue elasticity and the ciliary body developed world in symptoms, age and reduced QoL. However, there was (Weale 1962; Glasser et al. 2001; inadequate treatment of this condition, even with reading glasses. The Heys et al. 2004; Strenk et al. 2005; availability of reading glasses ranged from 6 to 45%. Activities of daily living McGinty & Truscott 2006; American could not be accomplished as easily without near correction of reading. Reasons Optometric Association 2010). An described for the lack of correction included: lack of access to medical care, poor important contribution to presbyopia awareness of decreased near vision, lack of motivation and cost. Overall scant is loss of lens viscoelasticity and lens data exist regarding presbyopia and its impact and how treatment affects QoL. growth that accompanies advancing Conclusions: This review suggests that the effect of presbyopia and its age (Burd et al. 2006). This loss of treatments on QoL remain poorly described and incompletely treated, especially lens elasticity may be at least in part in developing areas of the world. due to oxidized protein sulphydryl groups within lens fibre cells from Key words: presbyopia – public health – quality of life – treatment intraprotein cross-links that, over time, contribute to accommodative amplitude loss (Garner & Spector Acta Ophthalmol. 2014: 92: 497–500 1980; Lou & Dickerson 1992; Takem- ª 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd oto 1996; Bron et al. 2000; Hanson doi: 10.1111/aos.12308 et al. 2000; Lou 2003). Lens growth increases the inelastic mass that must change shape for accommodation to Introduction dation diminishes, the range of clear occur. vision may become inadequate for the Current treatments are corrective in Presbyopia is an age-related visual subject’s commonly performed near nature either by optical (bifocals, trifo- impairment that results from the grad- tasks. Presbyopia has been a known cals or contact lenses) or surgical ual decrease in accommodation affliction since ancient times and gen- (accommodative intra-ocular lenses or expected with age and may affect erated enough problems in society that laser or conventional corrective surgi- quality of vision and quality of life Plutarchus speculated to its mechanis- cal techniques) refractive modification. (QoL). As the amplitude of accommo- tic causes as long ago as 100 AD No current pharmaceutical treatment 497 Acta Ophthalmologica 2014 or remedy exists that reverses the vision health-related QoL. Monovision (Maxwell et al. 2008). The acquisition natural ageing of the lens. For a correction of presbyopia improved some cost associated with bilateral implan- condition that affects every adult, with measures of QoL, but it remained worse tation of two MF-IOLs was estimated a potentially deep lifestyle impact, very in younger subjects with emmetropia at $4000. Of the sample, 86% in the little information is available about the (McDonnell et al. 2003). MF-IOL and 8% in the monofocal QoL or financial impact of presbyopia Luo et al. (2008) demonstrated in a IOL group reported postoperative on society. cross-sectional study in 110 American spectacle independence. The net cost- The purpose of this review is to patients that presbyopia corrected with benefit of $11 670 in the MF-IOL examine the public health impact of glasses was associated with a nominal group exceeded the $155 net benefit in presbyopia regarding its effect on QoL decreaseinQoL,similartothatoftreated the conventional monofocal IOL group and society in both the developed and hypertension. Approximately 10% of over a period of 14 years. developing worlds. these patients suffered such inconve- Exploring a non-surgical correction nience from presbyopic correction that technique Polat and associates, in 30 Materials and Methods theymighthavebeencandidatesfornon- Israeli subjects, observed that percep- spectacle surgical intervention (Luo tual training tasks improved on average et al. 2008). Also, Spierer and Shalev, by about 17 words/min reading speed in Study criteria inaclinicaltrialof100healthyhyperopic presbyopes with uncorrected near vision The database was created (ADG) from Israelisubjects,notedthatlowamplitude (Polat et al. 2012). After training, a articles published between 2002 and 28 of accommodation at the age of 20 might presbyope would save approximately February 2013 found on PubMed predispose to earlier onset of presbyopia nine minutes when reading a 2000 word (www.pubmed.gov), Science Direct (Spierer & Shalev 2003). article at the smallest font size. (www.sciencedirect.com) and The Coch- In contrast, Leat and Mohr demon- rane Library (www.thecochranelibrary. strated that pre-presbyopes with prior Quality of life in the developing world com) using the following search terms: visual impairment, including children, presbyopia, QoL, accommodation, eco- had reduced accommodation (Leat & Patel et al. (2006) found in a cross- nomics, impact, cost, prevention, treat- Mohr 2007). Using a case–control sectional survey in 1564 African sub- ment and public health. Complete study, the authors examined 21 Cana- jects > 40 years of age that the preva- English language articles were dian low-vision patients with a variety lence of presbyopia was 62%. The retrieved, and studies were accepted of ocular conditions and indicated that majority of presbyopes (94%) did not into the database if they addressed the near visual deficit increased with have corrective near-vision glasses. presbyopia and public health. No spe- increasing accommodative demand. Compared with younger subjects, pres- cific exclusion criteria were defined for Several articles have investigated the byopia increased the odds of any dif- the study. change in QoL following refractive ficulty with near-vision tasks by Search terms (specified above) were treatment for presbyopia. Richdale twofold and the odds of having a searched twice in all utilized databases. and associates prescribed a contact lens difficulty with very demanding near- All articles meeting the above criteria for an eye with a previously implanted vision tasks by >eightfold. The degree were used in the analyses. Searches intra-ocular lens (IOL). The target of presbyopia was associated with were quality checked by two of the refraction for distance was emmetr- increasing difficulty with daily tasks other authors (LAN and WCS). The opia. They found at baseline, and after (Patel et al. 2006). authors must have agreed that the 1-month of contact lens use in 38 US Laviers et al. (2010) found in a article fulfilled the entry criteria. patients who completed the NEI-RQL cross-sectional, population-based study Data from articles meeting the study survey, that most (76%) preferred the of 381 Africans >40 years of age that criteria data were entered into an multifocal [SofLensâ Multi-Focal the prevalence of presbyopia was 89% Excel spreadsheet for each treatment. (polymacon) Visibility Tinted Contact (n = 340) and spectacle coverage was The ‘developed world’ data were Lens; Bausch & Lomb, Rochester, NY, 18% (n = 60). Barriers to accessing compiled from studies in Canada, USA] compared with monovision [Sof- services included spectacles not being France, Israel, Spain and the United Lensâ 59 (hilafilcon B) Visibility Tinted considered a priority by the patient and States. The ‘undeveloped world’ data Contact Lens; Bausch & Lomb] intra- insufficient funds to pay for glasses. At were collected from studies in Africa, ocular lens (IOL) correction alone follow-up, 175/187 (94%) of partici- Brazil, India, Nigeria, Saudi Arabia, (Richdale et al. 2006). The basis of pants given spectacles still had them. Tanzania, Thailand and Timor-Leste. the preference appeared to result from Average satisfaction was 90%. The the better vision and stereoacuity. mean amount subjects were willing to Results Stereoacuity was 158 Æ 220 seconds pay for spectacles increased