• 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]

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.

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:

1. Patient history
   1. Presenting problem and chief complaint
   2. Visual and ocular history
   3. General health history
   4. Medication usage and medication allergies
   5. Family eye and medical histories
   6. Vocational and avocational vision requirements
2. Visual acuity
   1. Distance visual acuity testing
   2. Near visual acuity testing
3. Refraction
4. Binocular vision and accommodation
   1. Plus lens to clear near vision
   2. Amplitude of accommodation
   3. Crossed cylinder test
   4. Accommodative convergence/accommodation ratio
5. Ocular health assessment and systemic health screening
6. Supplemental testing
   1. Positive and negative relative accommodation
   2. Near retinoscopy
   3. Intermediate distance testing

Management of Presbyopia:

A variety of options are available for optical correction of presbyopia, and the optometrist makes recommendations on the basis of the patient's specific vocational and avocational needs. It is the optometrist's responsibility to counsel the patient regarding these options and to guide the patient in the selection of appropriate eyewear. All types of corrections for presbyopia represent some visual compromise, compared with normal accommodative ability. Ultimately, the success of treatment depends on the lens power, the optical correction, and the specific visual tasks and characteristics of the individual patient.

The frequency and composition of evaluation and management visits for presbyopia are summarized in the table, below.

Frequency and Composition of Evaluation and Management Visits for Presbyopia

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.

An algorithm is provided for Optometric Management of the Patient with Presbyopia

The type of supporting evidence is not specifically stated for each recommendation.

• 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]

Not applicable: The guideline was not adapted from another source.

1998 (reviewed 2006)

American Optometric Association - Professional Association

Funding was provided by the Vision Service Plan (Rancho Cordova, California) and its subsidiary Altair Eyewear (Rancho Cordova, California)

American Optometric Association Consensus Panel on Care of the Patient with Presbyopia

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.

Not stated

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.

None available

This summary was completed by ECRI on December 1, 1999. The information was verified by the guideline developer on January 31, 2000.