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Book and Software Review
June 2003

Presbyopia: A Surgical Textbook

Author Affiliations



edited by Amar Agarwal, MS, FRCS, FRCOphth, 237 pp, $153, ISBN 1-55642-577-5, Thorofare, NJ, Slack Incorporated, 2002.


Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003

Arch Ophthalmol. 2003;121(6):924-925. doi:10.1001/archopht.121.6.924-a

This book covers a broad array of approaches that are important and relevant to understanding what surgical procedures might be of value in treating patients with presbyopia. The surgical techniques and required instrumentation are capably documented. Any modern text aiming to provide comprehensive coverage of surgical modifications for presbyopia must necessarily include topics that are investigational or controversial and should do so in an evenhanded manner. This textbook does indeed provide broad coverage of this developing field with chapters on these many and varied topics. Roughly half the 27 chapters address mainstream, accepted surgical procedures aimed at optical compensation for presbyopia, whereas the remaining chapters address controversial and unproved surgical restoration of accommodation. Section I deals with the physiology of accommodation and presbyopia with reference to much of the peer-reviewed literature. Unfortunately, as is inherent in books, this section lacks the discipline imposed by the peer review process and presents a confusion of theories, some more accurately portrayed than others. Sections II and IV describe scleral and lenticular modifications, with most chapters addressing accommodation restoration. The book fails to offer a sufficiently objective and skeptical critique of these controversial and investigational theories. To date there is no overwhelming scientific evidence that presbyopia can be reversed by restoring accommodation, either by scleral modifications or by replacement of the presbyopic crystalline lens with accommodative intraocular lenses. Although these are theories that have generated consider able scientific and clinical interest, there is a dearth of data supporting the notion that the procedures arisingfrom the theories actually restore accommodation. This book may be as much a source of misinformation for the unsuspecting novice seeking new information as it is an enlightening source of information for the seasoned skeptic. One might be led to believe that accommodation can actually be restored with these approaches, when this remains to be established. Section III documents some of the surgical procedures that provide optical compensation to relieve the symptoms of presbyopia through contact lenses, corneal multifocality or monovision, and intraocular multifocality or monovision. There is no differentiation between the sound and well-established optical principles that serve as the basis for optical compensation for presbyopia and the less well-accepted, controversial, and revisionist physiological theories that serve as the basis for the accommodation restoration approaches. A textbook that would be recognized as a definitive source of relevant information on a fast-evolving field with considerable controversy would benefit from clearly acknowledging the controversy and including sufficient critical evaluation, so the uninitiated can be exposed not just to innovations and surgical techniques, but also to the broader debate. The absence of a more critical perspective detracts from what might otherwise have been more widely regarded as a definitive text on presbyopic surgery.

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