Disclosure
The Food and Drug Administration (FDA) monitored Investigational Device Exemption (IDE) Clinical Trials for SRP (surgical reversal of presbyopia) have been showing tremendous promise. Vista Alliance Eye Care Associates has worked with Soloway's international and US patients to implement what has been a very successful postoperative regimen. Unlike LASIK and other refractive surgery procedures, SRP patients need to be motivated and disciplined in completing their accommodative rehabilitation to ensure optimal results. Luckily, this population of patients readily accepts whatever they must do to assist in living glasses-free. No one likes reading glasses; in fact, patients enjoy doing their exercises because they feel their eyes "working" and their vision becoming clearer.
As with other refractive surgery procedures, tear film quantity is extremely important. To ensure that vision is clear, it is recommended that patients use artificial tears every 1-2 hours for the first few weeks. It also is advisable during that time to insert silicone punctal plugs to help boost the tear lake with added convenience for the patient.
The postoperative rehabilitation schedule found most effective is daily accommodative training with what is called the "push-up/push-out" technique. First, have patients focus on 1 line above their best-uncorrected vision at 40 cm. Have patients slowly push-up the material until it blurs and can no longer be read clearly. Encouraging the patient to continue is one of the most important roles. The patient should be encouraged to move the material even closer and read it. When the patient has finished, he or she should begin in the blurry zone (close to the nose) and push-out until the material becomes clear. Patients should feel the eyestrain or accommodative scleromyalgia. This is good for a number of reasons; it demonstrates that the patients are accommodating and shows the patient that the eye is exercising and working to clear the print. This exercise should be performed 6-8 times in each eye, 4-5 times a day. The uncorrected near vision will continue to improve over the first few weeks. To start out, the patient can use a near card or a near Hart chart that will have larger print. As vision improves, normal reading materials, such as newspapers or magazines, can be used to make the task more enjoyable and to increase patient compliance. |
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It has been found that using eye exercises for postoperative rehabilitation should continue with the given regimen for at least 6 months. As with any form of exercise, maintenance is important. For patients to preserve their optimal level of accommodation, it is recommended that they should continue their accommodative training with their own reading material throughout life.
Surgical Reversal of Presbyopia: Optometric Postoperative Care excerpt | |||||||||||||||||||||||||||||||||||||||||||||
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