IF THERE IS ONE WORD THAT DESCRIBES THE EYE CARE profession so well, it is dynamic. It is so applicable in our evolving understanding of the aging of the eye. Now, this succinct adjective is so relevant as it describes the progress that frames the journey of our pharmacologic management options for presbyopia, as Dr. Milton Hom further explores. There are nuances to mechanisms of actions (MOA) differences in formulation strengths, preservative-free formulations, shorter and longer half-lives, different potential implications on the ciliary body, and others. And these are just the beginning of what has been learned so far! There is so much of how we will be able to work bi-directionally with MD/OD counterparts, and how we will be able to incorporate pharmacology with fewer spectacles, contact lenses, pseudophakes, and lasers!

Continuing on dynamism, I (EY) am often reminded when I evaluate patients who read Snellen lines well beyond what I would expect based on the maturity of the cataract, that it truly is the brain that sees, thus Dr. Selina McGee dives into how dynamic neuroadaptation helps the brain understand the visual images it receives. Neuroadaptation can help elevate quality of perception of vision with light-splitting IOLs, such as multifocal IOLs as explained by Dr. Vance Thompson. Also, check out the articles on laser blended vision (Presbyond) and refractive lens exchange/clear lens extraction as options for our presbyopia patients, and an explanation of biomechanics and kinematics as they relate to dynamic range of focus of the eye. We also get input from Drs. Ralph Chu and Jessica Heckman on experience with the first-in-class FDA-approved bifocal IOL.

Please enjoy this very comprehensive issue that continues to expand our understanding of presbyopia, and the management thereof. Thanks again, and see you soon.

Chief Co-Editors

Elizabeth Yeu, MD and Jacob Lang, OD

Dr. Yeu joined Virginia Eye Consultants in 2013, has been a partner since 2014, and continues her commitment to residency training in ophthalmology as an assistant professor of ophthalmology at the Eastern Virginia Medical School. She is medical director of the CVP Mid-Atlantic Surgery Center and sits on the board of directors for the Virginia Eye Foundation.

Dr. Lang is the lead optometrist at Associated Eye Care in Minnesota and is the director of the practice’s ocular disease residency program. He specializes in cornea and ocular surface diseases, as well as therapeutic contact lenses and surgical comanagement. He is also adjunct clinical faculty at the Illinois College of Optometry, The Ohio State University, and Salus University.