The Etiology of Presbyopia, Contributing Factors, and Future Correction Methods

Presbyopia has been a complicated problem for clinicians and researchers for centuries. Defining what constitutes presbyopia and what are its primary causes has long been a struggle for the vision and scientific community. Although presbyopia is a normal aging process of the eye, the continuous and gradual loss of accommodation is often dreaded and feared. If presbyopia were to be considered a disease, its global burden would be enormous as it affects more than a billion people worldwide. In this dissertation, I explore factors associated with presbyopia and develop a model for explaining the onset of presbyopia. In this model, the onset of presbyopia is associated primarily with three factors; depth of focus, focusing ability (accommodation), and habitual reading (or task) distance. If any of these three factors could be altered sufficiently, the onset of presbyopia could be delayed or prevented. Based on this model, I then examine possible optical methods that would be effective in correcting for presbyopia by expanding depth of focus. Two methods that have been show to be effective at expanding depth of focus include utilizing a small pupil aperture or generating higher order aberrations, particularly spherical aberration. I compare these two optical methods through the use of simulated designs, monitor testing, and visual performance metrics and then apply them in subjects through an adaptive optics system that corrects aberrations through a wavefront aberrometer and deformable mirror. I then summarize my findings and speculate about the future of presbyopia correction.