Presbyopia treatment aims to rejuvenate ‘lazy’ ciliary muscles

By Cheryl Guttman Krader

Las Vegas-Microelectrostimulation of the ciliary body is a promising non-invasive technique for restoring accommodative loss in eyes with early presbyopia, said Luca Gualdi, MD.

The treatment involves delivery of electric impulses that cause rhythmic contraction of the pupillary muscles with alternating miosis and mydriasis. It is based on the concept that as presbyopia develops and people begin to use reading glasses, the ciliary muscle becomes “lazy” from lack of use, said Dr Gualdi at the 2015 meeting of the American Academy of Ophthalmology.

Dr. Gualdi presented results from an initial small series of patients who ranged in age from 40 to 50 years, were emmetropes or had low hyperopia (maximum +0.25 D), and had early presbyopia (maximum +1.5 D add).

Testing showed a tendency for improvement in near visual acuity in all eyes. Uncorrected visual acuity at 40 cm (near) and 70 cm (intermediate) improved significantly after just two treatments, and the improvement in near vision was accompanied by a significant reduction in mean reading speed time.

Accommodative amplitude improved based on subjective testing (Duane test), and findings from ultrasound biomicroscopy and aberrometry provided objective evidence of accommodation.

“The efficacy and long-term results of this treatment will be confirmed with continued study,” said Dr. Gualdi, Rome, Italy. “In addition, we anticipate future upgrades and optimizations of the parameters that will deliver even better results.”

Dr. Gualdi noted there have been previous studies investigating electrostimulation in the eye that support its safety.

In the procedure for treating early presbyopia, a 20-mm polycarbonate scleral contact lens is placed on the eye, reaching 3.5 mm from the limbus.

The contact lens contains four electrodes, and it is connected via cables to the electrostimulator (i-TECH).

Rhythmic, low voltage electric impulses are delivered over a period of 8 minutes to each eye, inducing passive exercise to the ciliary body that increases its dimensions, contraction strength, and efficiency, Dr. Gualdi said.

The procedure is done with anesthetic, although patients can feel a small tingling effect on the lids or in the whole eye.

“It is not painful,” Dr. Gualdi said.

Patients use a topical anti-inflammatory medication or artificial tears post-treatment.
Based on the early results, Dr. Gualdi suggested the procedure should be performed with an “attack dose” consisting of two treatments within 1 month. Then, beginning 2 to 3 months later, patients should begin a maintenance regimen, returning every 3 months for a repeat treatment.