What is Presbyopia (age-related long-sightedness) syndrome?

From the Guidelines

Presbyopia syndrome, commonly referred to as Pres syndrome, is a condition that develops with aging, resulting in insufficient accommodation for near work, and its management can be divided into nonsurgical and surgical approaches, with the most recent evidence suggesting topical therapy, such as Pilocarpine HCL 1.25%, as a viable treatment option. The management of presbyopia includes various methods, such as:

• Nonsurgical management, including eyeglasses (reading glasses, bifocal, trifocal, or progressive lenses) and contact lenses (soft or rigid gas-permeable with aspheric bifocal or multifocal optics) 1
• Topical therapy, with Pilocarpine HCL 1.25% being approved by the FDA for the treatment of presbyopia 1
• Monovision strategies, which involve using a bifocal or multifocal contact lens in one eye and a distance contact lens in the fellow eye 1
• Modified monovision, which is the use of a bifocal or multifocal contact lens in one eye and a distance contact lens in the fellow eye 1

The primary goal of treatment is to improve near vision while maintaining distance vision, and the choice of treatment depends on the individual patient's needs and preferences. According to the most recent study published in 2023, topical therapy with Pilocarpine HCL 1.25% is a preferred treatment option for presbyopia 1. It is essential to note that presbyopia is a common condition that affects many people, and its management should be tailored to each individual's specific needs.

In terms of contact lens options, soft hydrogel and rigid gas-permeable bifocal or multifocal contact lenses can be used to address presbyopia 1. Additionally, monovision can be used, where the dominant eye is corrected for distance and the nondominant eye for near 1. Patients wearing monofocal contact lenses may benefit from eyeglasses worn over the contact lenses while driving, especially at night, or for critical visual needs to correct the near eye for distance and thereby improve depth perception 1.

Overall, the management of presbyopia requires a comprehensive approach, taking into account the individual patient's needs and preferences, and the most recent evidence suggests that topical therapy, such as Pilocarpine HCL 1.25%, is a viable treatment option 1.

From the Research

Definition and Symptoms of Posterior Reversible Encephalopathy Syndrome (PRES)

• Posterior reversible encephalopathy syndrome (PRES) is a serious neurological disorder consisting of headache, visual disturbances, seizures, impaired consciousness, and radiological evidence of posterior cerebral edema 2.
• The syndrome may present with a broad range of clinical symptoms from headache and visual disturbances to seizure and altered mentation 3.
• Typical symptoms of PRES include altered mental status, seizures, headaches, and other focal neurological deficits 4.

Risk Factors and Causes of PRES

• The main known risk factors for PRES are hypertension, pre-eclampsia, eclampsia, acute kidney injury, and numerous drugs 2.
• Chemotherapeutic agents, such as platinum-containing drugs, Cyclophosphamide, Hydroxydaunorubicin/Adriamycin, Oncovin/Vincristine, Prednisone/R-CHOP regimens, and gemcitabine, are commonly associated with PRES 5.
• Immunosuppressant agents and drugs that can increase blood pressure or fluid and sodium retention are also implicated in the development of PRES 2, 4.

Diagnosis and Imaging Findings of PRES

• Diagnosis of PRES is typically made with the help of MRI findings, which involve the subcortical white matter of parieto-occipital lobes 4.
• Symmetrical white matter abnormalities suggestive of edema are seen in CT and MRI scans, commonly but not exclusively in the posterior parieto-occipital regions of the cerebral hemispheres 6.
• Diffusion-weighted MRI scans are important for early diagnosis and differentiation from other causes of altered sensorium 6.

Treatment and Management of PRES

• Management of PRES is chiefly concerned with stabilization of the patient, adequate and prompt control of blood pressure, prevention of seizures, and timely caesarean section in obstetric cases with pre-eclampsia/eclampsia 6.
• Supportive management alone is often sufficient, and most cases of PRES improve within days to weeks after elimination of the causal factor 2, 5.
• Discontinuation of cytotoxic agents may be life-threatening due to graft rejections or graft versus host disease, making management of PRES caused by these agents challenging 4.