视光学理论与方法：OTM-老视.pdf

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1、Presbyopia:NearrefractionandmanagementJingjingXuWenzhouMedicalUniversity2015-11-11•Presbyopia:–Greek:oldeyesPresbyopia•Definition:reductioninaccommodativeabilityoccurringnormallywithageandnecessitatingapluslensadditionforsatisfactoryseeingatnear.•Epidemiologist:everyonegetpr

2、esbyopia•EtiologyPresbyopia•Sometimesquantitativelydefinedbyanamplitudeofaccommodationoflessthan5Dorbytherecessionofthenearpointofaccommodationbeyond20cmWhy5D?•Absolutepresbyopia–Emmetrope–Myope–hyperope•Borderlinepresbyopia–Slow–NeedplusbutrejectsEtiologyofpresbyopia•Helmho

3、ltz(1855):gradualhardeningorsclerosisofthecrystallinelenssubstance•Doners(1864):weakeningoftheciliarybody•Fincham(1973):newfibersareaddedtothecortexofthelensthroughoutlifecompressingandhardeningthenuclearfibersWhatisthechiefcomplaintofthepresbyope?Myarmistooshort!Onsetandpro

4、gressionofpresbyopia•Amp.Acc<5.0D•36-50AmplitudeofaccommodationAgeDonders’Duane’sHofstetter’sHofstetter’stableTableMinimummaximum355.56.56.2511404.55.55.09.0453.53.53.757.0502.53.02.55.0Accommodationvsage(EmsleyafterDuane)12108642AccommodationMonocularAmplitudeof1-0D94101520

5、2530354045506070AgeTheonsetofsymptomsofpresbyopiavarieswith•Refractivetype–Hyperopes:early–Myopes:later•Usageofeyes•Thephysicalattributesofpatient•Geographiclocationofthepatient•medicationsTheonsetofsymptomsofpresbyopiavarieswith•Refractivetype•Usageofeyes–Detailedclosework:

6、earlynoticethechanges•Thephysicalattributesofpatient•Geographiclocationofthepatient•medicationsTheonsetofsymptomsofpresbyopiavarieswith•Refractivetype•Usageofeyes•Thephysicalattributesofpatient–Talllongarmedguys:later•Geographiclocationofthepatient•medicationsTheonsetofsympt

7、omsofpresbyopiavarieswith•Refractivetype•Usageofeyes•Thephysicalattributesofpatient•Geographiclocationofthepatient–Equatorvsloweraltitudes•medicationsTheonsetofsymptomsofpresbyopiavarieswith•Refractivetype•Usageofeyes•Thephysicalattributesofpatient•Geographiclocationofthepat

8、ient•Medications–Insulin,anti-anxietyagents,anti-depressants,anti-psychotic