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Presbyopia. How to reverse it. Thierry Hertoghe, MD. Presbyopia. The name comes from the Greek: “ presbys ” =“ old man ” “ ops ” = “ sight” meaning “ seeing as old men do .” = form of farsightedness => develops in middle and old age. Presbyopia.
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Presbyopia How to reverse it Thierry Hertoghe, MD
Presbyopia • The name comes from the Greek: • “presbys” =“old man” • “ops” = “sight” • meaning “seeing as old men do.” • = form of farsightedness => develops in middle and old age
Presbyopia = farsightedness = loss of near vision acuity, text or an object50 cm (19.7 inches) or less away appears blurred.
Presbyopia: Frequency Presbyopia starts early – at ages 35-40 in a nonnegligible part of the population – but not all people below age 70 have presbyopia. A Nepalese study reported that 66% of Nepalese citizens age 35 or over suffer from presbyopia. In China, the prevalence is similar (67%) among people age 40 or over. At ages 40 to 49, 28% of the Chinese have already presbyopia, while the incidence is 82% for 60- to 69-year-olds.
Presbyopic eye How to reverse it it
= Adjustment of the eye and vision to objects situated at various distances, especially close by Accommodation Newspaper Smartphone The eye adjusts by changing the curvature of the lens.
= Adjustment of the eye and vision to objects situated at various distances, especially close by Accommodation The eye adjusts its vision to objects situated at various distances, especially close, by changing the curvature of the lens through different levels of contraction of the ciliary muscles . The ability of the lens to accommodate = “refractive power” = “optical power”) of the eye
= Ability of the lens to accommodate Refractive power = “optical power”) of the eye. In humans, the total refractive powerof a young and relaxed eye is about 60 diopters. Two-thirds (± 40 diopters) are provided by the cornea => do no offer much, if any, accommodation because the corneal convexity cannot substantially change. One third (± 20 diopters)is offered by the crystalline lens => permits accommodation
Amplitude of accommodation is = the maximum change in focus that an eye can achieve to see objects at a distance sharply.
The amplitude of accommodation declines with age In humans, the amplitude of accommodation declines from ± 15 to 20 diopters in the very young => 10 diopters at age 25 => 1 diopter at age 50 and over.
Presbyopia: Exposure to light, esp. UV rays • HUMANS: people regularly exposed to solar light rays without sunglasses for protection get presbyopia more quickly, early onset presbyopia • ANIMALS: constant exposure to light – day and night – makes animal eyes hypermetropic or what is called “presbyopic” in old agew
High temperature in the environment= worse predisposing factor to presbyopia than UV rays Colombia, Bolivia, Peru, & Ecuador Mountainous areas with average low temperatures Coastal regions with mean high temperatures Much higher exposure to ultraviolet rays UV rays is ± 1-2% at sea level UV rays up to 5-6% at high altitudes Coastal areas => Presbyopia develops at an earlier age
High temperature in the environment= worse predisposing factor to presbyopia than UV rays Ecuador Ecuadorian mountains with average annual temperature = 13 °C (= 55 °F) Coast of Ecuador with average annual temperature = 25.5 °C (= 78 °F) Much higher exposure to ultraviolet rays Presbyopia starts at median age of 42.5 years Presbyopia starts at median age of 39.7 years
environmental temperature => lens sensitivity to the external temperature the temperature at the center of the rabbit lens is about 26.7 °C (80 °F), For an environmental temperature of 23.9 °C (= 75 °F). nearly 3 °C higher than the outside temperature! Small increases in environmental temperature above 23.9 °C (= 75 °F) => 4x more temperature changes in the lens than at environmental temperature of 10 °C (= 50 °F)!
Presbyopia: Dietary deficits Low fish intake In the Brazilian Amazon, inhabitants who present the lowest blood levels of the omega-3 fatty acid DHA (docosahexaenoic acid) are nearly three times more likely to develop near vision acuity (hypermetropia or presbyopia) than people with the highest levels. The former individuals are not eating sufficient amounts of fish, which is the major food source of DHA.
Presbyopia: Hormone deficits Melatonin deficits Testosterone deficits Growth hormone deficit (promotes hypermetropia in children) IGF-1 and insulin deficits in childhood it
Adults with type 1 diabetes: accomodation • Type 1 diabetes • Young adults with type 1 diabetes are less able to adjust their vision to nearby objects at different distances. • ± 34% lower objective accommodation amplitude, as controlled with ophthalmologic devices. • 29% lower subjective accommodation amplitude, as reported by the patient. • The accommodative loss worsens as the duration of diabetesincreases, which is a reason to treat diabetes on time. Young adults with insulin deficiency
Lifestyle changes to prevent presbyopia Wear sunglasses to delay presbyopia
Lifestyle changes to prevent presbyopia Live in colder climate or … put the air conditioning on Why not … Belgium?
Presbyopia: Diet Eat fish to delay presbyopia
Presbyopia: Bilberry & black currant extracts Bilberry and black currant extracts improve visual acuity, including near vision activities Let’s mention bilberry and black currant extracts, which are rich in flavonoids – anthocyanosides, in particular, are well-known to improve visible acuity. Bilberries Black currant Oral caps Black currant extract Dose:2x 50 mg /day Bilberry extract Dose:2x 25-100 mg /day
Presbyopia: Vitamin A + Melatonin eye drops? the administration of vitamin A eye drops (in association with melatonin) reverses or minimizes the development of hypermetropia in older rodents. • Dose: 2x drop/day of an ophthalmic solution of • Melatonin 0.05% • Vitamin A 0.5%
Presbyopia Astragalus 2 Telomerase activators Astragalus root extract: 2 x 1 caps (5-10 mg)/day + Epithalon: 3 mg/day sublingual Epithalon= Ala-Glu-Asp-Gly
Astragalus root extract Astragalus root extract Astragalus root extract
Hypermetropia in children: Treat GH deficiency Children with growth hormone deficiency Growth hormone therapy in growth hormone-deficient patients with hypermetropia may correct the hypermetropia well, especially in children who are more flexible, as shown in a report on 45 adults with growth hormone deficiency.
Hypermetropia in children: Treat insulin deficiency Young adults with insulin deficiency Treat type 1 diabetes with insulin as soon as possible Start treating type 1 diabetes as soon as possible with insulin, especially during childhood – a period of life where the eye is still growing – as insulin makes the eye longer in growing subjects.
Presbyopia in adults: Treat GH, IGF-1 & insulin deficiencies Although no double-blind placebo-controlled study on GH, IGF-1 or insulin treatment of presbyopia has been done (yet) , supplying GH, IGF-I, and insulin to patients with presbyopia and low insulin or IGF-I levels might offer relief, or at least counter further aggravation of farsightedness. => Studies showing IGF-1 and insulin receptor deficits to favor the development of shorter hypermetropic eyes by atrophy.
Presbyopia : Hormone mesotherapy with vasodilatators reverses presbyopia in adults
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