Presbyopia: in pursuit of youthful vision

“I’m very honoured to be giving this presentation at this great university,” said Prof Wolffsohn, acknowledging Sir John Hood who “really saw the benefit in exchange” between university researchers. In an ageing population, “we want to remain healthy so this whole concept of healthy ageing is very important to organisations like WHO,” he said. “So how can we extend our lifespan and do that in a healthy way?”

Prof Wolffsohn’s presentation spanned the layered, historical context of presbyopia and the challenges and advances in modern medical science. From circa 1760, when Benjamin Franklin “arguably” created the first bifocal lenses to the first commercially viable varifocal design in 1959 by Essel (Société des Lunetiers; later known as Essilor), Prof Wolffsohn took his audience on an educational odyssey spanning the ancient Greeks - the Latin definition of presbyopia is ‘to see like an old man’ - to current and ongoing research into smartphones, tablets and social media.

Access to eyecare is vital, he said. “Here you can go to an optometrist and get a prescription or diagnosis that will overcome the symptoms of presbyopia. But in many countries that is not possible. “It’s really about people’s ability to do tasks. As you can imagine, if you lose your near sight, your ability to work and function, that is serious and hence why the World Health Organization is so interested in this.”

As if our own DNA shifts and mutations as we age were not obstacle enough, we are living longer, said Prof Wolffsohn. “Perhaps we weren’t designed to live as long as we do now. How can we use modern science to improve that, to give us that longer lifespan and, of course, concentrate on the ocular part of that?”

Insights into the ocular and systemic conditions that determine a person’s propensity to presbyopia include an individual’s pupil size, tolerance to blur and geographic latitude, he explained. “If you live closer to the equator you generally lose your eye focus earlier. That might be to do with ultraviolet radiation, diet and other things. If you’re long-sighted you’ll notice earlier; if you’re near-sighted, you’ll notice earlier as well and it will be more rapid.”

With the march of technology comes a swathe of options. To chuckles from the audience, Prof Wolffsohn said these include accessibly to products via channels such as AliExpress – “little stickers you can stick on your glasses and create the bifocal effect”. There are also other “weird and wonderful things” out there, he said, like electrostimulation.

The methods of assessment, advancements in and benefits of technology, from spectacles and contact lenses to intraocular lenses, refractive surgery and pharmaceuticals, ultimately led Prof Wolffsohn to the key take-home message: “If you’re using one form of correction it probably won’t work… Surveys indicate people use multiple different forms of correction for different environments.”

Since technology is changing all the time, it is vital to be cognisant of the limitations of older methods of assessment and diagnosis, such as near-vision charts which used letters from old printing presses. It’s also important to be aware of the possibilities of newer tools, such as social media, he said, “where a lot of people talk about their loss of vision… There are new ways of accessing our patients and what’s happening to them.”

Acknowledging centuries of progress, economic and scientific travails, the ultimate end goal of restoring some of that natural accommodation is human-lens regeneration – the ability to regrow or reshape our own lens in the future, said Prof Wolffsohn. “Demonstrations of that show potential, but we’re not there yet.”

Bringing the lecture to a close, Professor Warwick Bagg, dean of the Faculty of Medical and Health Sciences, thanked Prof Wolffsohn for “a truly inspiring lecture… and for stimulating our thoughts on how we might be able to grow our eyes back!”