Guideline:
Care of the patient with presbyopia
Bibliographic Source(s)
- American Optometric Association. Care of the patient with presbyopia. 2nd ed. St. Louis (MO): American Optometric Association; 1998. 61 p. (Optometric clinical practice guideline; no. 17). [115 references]
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Category
Diagnosis
Evaluation
Management
Intended Users
Health Plans
Optometrists
Guideline Objective(s)
- Identify patients at risk of developing functional disability as the result of presbyopia
- To effectively examine the vision status of patients with presbyopia
- To accurately diagnose presbyopia Evaluate the appropriate treatment options for the patient with presbyopia
- To minimize the visual disability due to presbyopia through optometric care
- To inform and educate patients and other health care practitioners about the visual consequences of presbyopia and the available treatment options.
Target Population
Adult patients
Interventions and Practices Considered
Diagnosis
- Patient History
- Ocular Examination
- Visual Acuity
- Refraction
- Binocular Vision and Accommodation
- Ocular Health Assessment and Systemic Health Screening
- Supplemental Testing
Treatment
- Optical Correction with Spectacle Lenses
- Optical Correction with Contact Lenses
- Combination of Contact and Spectacle Lenses
- Refractive Surgery
- Experimental Surgical Techniques
Major Outcomes Considered
Not stated
Methods Used to Collect/Select Evidence
Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases
Description of Methods used to Collect/Select the Evidence
The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.
Number of Source Documents
Not stated
Methods Used to Assess the Quality and Strength of the Evidence
Expert Consensus (Committee)
Rating Scheme for the Strength of the Evidence
Not applicable
Methods Used to Analyze the Evidence
Review
Description of the Methods Used to Analyze the Evidence
Not applicable
Methods Used to Formulate the Recommendations
Not stated
Rating Scheme for the Strength of the Recommendations
Not applicable
Cost Analysis
A formal cost analysis was not performed and published cost analyses were not reviewed.
Method of Guideline Validation
Internal Peer Review
Description of Method of Guideline Validation
The Reference Guide for Clinicians was reviewed by the American Optometric Association (AOA) Clinical Guidelines Coordinating Committee and approved by the AOA Board of Trustees.
Major Recommendations
Diagnosis of Presbyopia:
This Guideline describes the optometric care provided for a patient with presbyopia. The examination components described herein are not intended to be all inclusive because professional judgment and the individual patient's symptoms and findings may have significant impact on the nature extent and course of the services provided. The potential components of the diagnostic evaluation for presbyopia include the following areas:
- Patient history
- Presenting problem and chief complaint
- Visual and ocular history
- General health history
- Medication usage and medication allergies
- Family eye and medical histories
- Vocational and avocational vision requirements
- Visual acuity
- Distance visual acuity testing
- Near visual acuity testing
- Refraction
- Binocular vision and accommodation
- Plus lens to clear near vision
- Amplitude of accommodation
- Crossed cylinder test
- Accommodative convergence/accommodation ratio
- Ocular health assessment and systemic health screening
- Supplemental testing
- Positive and negative relative accommodation
- Near retinoscopy
- Intermediate distance testing
Management of Presbyopia:
A variety of options are available for optical correction of presbyopia and theoptometrist makes recommendations on the basis of the patient's specific vocational andavocational needs. It is the optometrist's responsibility to counsel the patient regardingthese options and to guide the patient in the selection of appropriate eyewear. All typesof corrections for presbyopia represent some visual compromise compared with normalaccommodative ability. Ultimately the success of treatment depends on the lens power theoptical correction and the specific visual tasks and characteristics of the individualpatient.
The frequency and composition of evaluation and management visits for presbyopia aresummarized in the table below.
Frequency and Composition of Evaluation and Management Visits for Presbyopia
Type of Patient | Number of Evaluation Visits | Treatment Options | Frequency of Follow-Up Visits* | Composition of Follow-Up Evaluations | Management Plan | |||
VA | REF | A/V | OH | |||||
| Incipient presbyopia | 1 to 2 | Optical correction; modify habits and environment | 1 to 2 yr | Each visit | Each visit | Each visit | Each visit | No treatment or provide refractive correction; educate patient |
| Functional presbyopia | 1 to 2 | Optical correction | 1 to 2 yr | Each visit | Each visit | Each visit | Each visit | Provide refractive correction; educate patient |
| Absolute presbyopia | 1 | Optical correction | Annually | Each visit | Each visit | Each visit | Each visit | Provide refractive correction; educate patient |
| Premature presbyopia | 2 to 3 | Optical correction | 3 to 6 mos | Each visit | p.r.n. | Each visit | p.r.n. | Address ocular or general health issues; provide refractive correction; educate patient; monitor |
| Nocturnal presbyopia | 1 to 2 | Optical correction; modify habits and environment | 1 to 2 yr | Each visit | Each visit | Each visit | Each visit | No treatment or provide refraction; educate patient |
VA = visual acuity testing
REF = refraction
A/V = accommodative/vergence testing
OH = ocular health assessment
p.r.n. = as needed
* Patients prescribed contact lenses may require more frequent follow-up to monitor eye health lens performance.
Clinical Algorithm(s)
An algorithm is provided for Optometric Management of the Patient with Presbyopia
Type of Evidence supporting the Recommendations
The type of supporting evidence is not specifically stated for each recommendation.
Potential Benefits
The evaluation and management of presbyopia are important because significant functional deficits can occur when the condition is left untreated. Furthermore the onset of presbyopia frequently motivates the individual to seek eye care presenting the optometrist the opportunity to check for the presence of other disorders some of which might threaten sight or life. This opportunity underscores the public health benefit of comprehensive optometric care for patients with presbyopia. As primary eye care providers optometrists have the expertise to examine diagnose treat and manage a wide variety of eye and vision problems. For patients requiring other health care services related to systemic conditions detected in the course of their eye examination the optometrist becomes the point of entry into the broader health care system.
Undercorrected or uncorrected presbyopia can cause significant visual disability and have a negative impact on the patient's quality of life. Gaining an understanding of the patient's specific vocational and avocational visual requirements helps the optometrist recommend the treatment most appropriate for enhancing visual performance. Traditional treatment options include single vision and multifocal spectacle and contact lenses. Although each of these options requires some degree of compromise and adaptation the patient with presbyopia who receives appropriate optometric care can continue to function well.
Potential Harms
There are a range of possible side effects associated with refractive surgery including overcorrection undercorrection induced astigmatism regression delayed epithelial healing stromal haze diplopia and ocular tenderness.
Qualifying Statements
Clinicians should not rely on this Clinical Guideline alone for patient care and management. Please refer to the references and other sources listed in the original guideline for a more detailed analysis and discussion of research and patient care information.
Description of Implementation Strategy
An implementation strategy was not provided.
Implementation Tools
Clinical Algorithm
Patient Resources
For information about availability see the "Availability of Companion Documents" and "Patient Resources" fields below.
IOM Care Need
Getting Better
IOM Domain
Effectiveness
Patient-centeredness
Bibliographic Source(s)
- American Optometric Association. Care of the patient with presbyopia. 2nd ed. St. Louis (MO): American Optometric Association; 1998. 61 p. (Optometric clinical practice guideline; no. 17). [115 references]
Adaptation
Not applicable: The guideline was not adapted from another source.
Source(s) of Funding
Funding was provided by the Vision Service Plan (Rancho Cordova California) and its subsidiary Altair Eyewear (Rancho Cordova California)
Guideline Committee
American Optometric Association Consensus Panel on Care of the Patient with Presbyopia
Composition of Group that Authored the Guideline
Members: Gary L. Mancil O.D. (Principal Author); Ian L. Bailey O.D. M.S.; Kenneth E. Brookman O.D. Ph.D. M.P.H.; J. Bart Campbell O.D.; Michael H. Cho O.D.; Alfred A. Rosenbloom M.A. O.D. D.O.S.; James E. Sheedy O.D. Ph.D.
AOA Clinical Guidelines Coordinating Committee Members: John F. Amos O.D. M.S. (Chair); Kerry L. Beebe O.D.; Jerry Cavallerano O.D. Ph.D.; John Lahr O.D.; Richard L. Wallingford Jr. O.D.
Financial Disclosures/Conflicts of Interest
Not stated
Guideline Status
This is the current release of the guideline.
According to the guideline developer this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.
Guideline Availability
Electronic copies: Available in Portable Document Format (PDF) from the American Optometric Association Web site.
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881
Availability of Companion Documents
None available
Patient Resources
The following is available:
- Answers to your questions about presbyopia. St. Louis MO: American Optometric Association. (Patient information pamphet).
Print copies: Available from the American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141-7881; Web site www.aoanet.org.
Please note: This patient information is intended to provide health professionals with information to share with their patients to help them better understand their health and their diagnosed disorders. By providing access to this patient information it is not the intention of NGC to provide specific medical advice for particular patients. Rather we urge patients and their representatives to review this material and then to consult with a licensed health professional for evaluation of treatment options suitable for them as well as for diagnosis and answers to their personal medical questions. This patient information has been derived and prepared from a guideline for health care professionals included on NGC by the authors or publishers of that original guideline. The patient information is not reviewed by NGC to establish whether or not it accurately reflects the original guideline's content.
NGC STATUS
This summary was completed by ECRI on December 1 1999. The information was verified by the guideline developer on January 31 2000.
COPYRIGHT STATEMENT
This NGC summary is based on the original guideline which is subject to the guideline developer's copyright restrictions as follows:
Copyright to the original guideline is owned by the American Optometric Association (AOA). NGC users are free to download a single copy for personal use. Reproduction without permission of the AOA is prohibited. Permissions requests should be directed to Jeffrey L. Weaver O.D. Director Clinical Care Group American Optometric Association 243 N. Lindbergh Blvd. St. Louis MO 63141; (314) 991-4100 ext. 244; fax (314) 991-4101; e-mail JLWeaver@AOA.org.
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