Volume 62 · Issue 08 · 2026

This issue focuses on the research progress of presbyopia correction. The responsible editorial committee responsible for the planning, composition and review of this issue is Professor Zhang Fengju.

Presbyopia is one of the most common visual functional problems in middle-aged and older adults. With the increasing availability of correction options, presbyopia care has evolved from traditional near-vision compensation to comprehensive clinical decision-making that integrates visual quality, risk control, and long-term eye health management. However, the traditional single-specialty model is becoming insufficient to comprehensively address key aspects of presbyopia care, including assessment of visual needs, screening of ocular conditions, identification of systemic risk factors, selection of correction strategies, perioperative management, and long-term follow-up. This article discusses the limitations of the single-specialty model in presbyopia correction and the necessity of strengthening multispecialty management, aiming to provide a reference for individualized, precise, and standardized implementation of presbyopia care.

Presbyopia is a common visual health problem among middle-aged and older adults, affecting the quality of near vision and quality of life. With continuing advances in the individualized, precise, and longitudinal management of presbyopia, as well as the ongoing development of correction technologies, including functional spectacles, laser corneal refractive surgery, posterior chamber phakic intraocular lens implantation, and refractive lens exchange, a single-specialty model of presbyopia care may no longer adequately meet the growing visual health needs of people with presbyopia or the requirements for high-quality clinical care. In response, the Chinese Optometric Association of Chinese Ophthalmological Society and the Presbyopia Diagnosis and Treatment Academic Division of the Ophthalmology Professional Committee of the Chinese Non-government Medical Institutions Association jointly convened experts from relevant fields across China. Based on the available evidence and clinical experience, and using standardized methods for guideline and consensus development, the expert panel addressed 11 clinical questions concerning presbyopia correction and its multispecialty management and formulated 23 consensus recommendations. This consensus aims to provide guidance and reference for the standardized clinical practice of presbyopia correction.

Keratoconus is a common blinding corneal disease among young adults. A large number of atypical or early-stage patients are highly susceptible to missed diagnosis or misdiagnosis due to unremarkable clinical manifestations, leading to the loss of opportunities for early effective intervention and management, and ultimately resulting in irreversible blindness. In recent years, with the expansion of the population undergoing corneal refractive surgery, establishing an accurate screening and diagnostic system for keratoconus has important clinical significance for preventing postoperative complications. In view of this, the Refractive Surgery Group of the Ophthalmology Branch of the Chinese Medical Doctor Association, in collaboration with the Corneal Disease Group of the Ophthalmology Branch of the Chinese Medical Association, has developed consensus opinions on confusing concepts and terms related to early keratoconus, as well as the strategies, criteria, methods and systems for the early screening and diagnosis of keratoconus, based on relevant domestic and international consensus, evidence-based medicine evidence and expert clinical experience, using scientific and standardized methods. This consensus aims to continuously establish and improve the early screening and diagnostic pathway for keratoconus, which not only provides a scientific basis for the preoperative evaluation of corneal refractive surgery and enhances the safety of corneal refractive surgery, but also offers a reference for the early clinical diagnosis and treatment of keratoconus.

To evaluate the efficacy and safety of a novel silicone hydrogel multifocal soft contact lens for presbyopia correction, and to verify its non-inferiority compared with a conventional hydrogel multifocal contact lens.

This was a prospective, randomized, open-label, parallel-group, multicenter non-inferiority clinical trial. From October 2024 to July 2025, 195 presbyopic subjects aged ≥40 years with near add power of +0.75 to +2.50 D were screened at 5 centers (Eye Hospital of Wenzhou Medical University, Eye & ENT Hospital of Fudan University, and Shenzhen Eye Hospital, Qingdao Eye Hospital of Shandong First Medical University, and Shanxi Eye Hospital Affiliated to Shanxi Medical University), and 180 were enrolled and randomized (computer-generated random number method) 1∶1 to the test group (samfilcon A silicone hydrogel multifocal soft contact lens, n=90) or the control group (polymacon hydrogel multifocal soft contact lens, n=90). Both type of lenses were monthly disposable for daily wear. Binocular corrected distance visual acuity (5 m) and near visual acuity (40 cm) were measured at each visit using a standard logarithmic visual acuity chart (5-point recording method). Subjective wearing experience was assessed by a validated acceptability questionnaire, and ocular surface status was evaluated via tear break-up time (TBUT) and corneal fluorescein staining. The primary endpoint was the wearing success rate at 1 week, defined as binocular corrected distance visual acuity ≥4.9 and near visual acuity ≥4.7. Missing values were imputed using the worst observation carried forward method. Rate differences and 95% confidence intervals (CI) were calculated by the Newcombe-Wilson method. Between-group comparisons were performed using Fisher exact test, independent-samples t test, or Wilcoxon rank-sum test. Sensitivity analysis was performed using the Cochran-Mantel-Haenszel method stratified by center. The non-inferiority margin was prespecified as -10%.

The full analysis set comprised 177 subjects (87 in the test group, 90 in the control group), with a mean age of (47.1±4.7) years, including 33 males and 144 females. After the data imputation, the wearing success rate at 1 week was 100.0% in both groups, with a rate difference of 0.00% (95%CI:-4.23% to 4.09%), meeting the non-inferiority criterion. Sensitivity analysis of raw data showed success rates of 96.6% and 96.7% in the test and control groups, respectively (adjusted rate difference -0.00%, P=0.991), consistent with the primary analysis. At all visits, binocular corrected visual acuities were within normal ranges in both groups, with no significant between-group differences (all P>0.05). Contact lens-corrected visual acuity was slightly lower than best spectacle-corrected visual acuity in both groups, with mean differences of approximately 0.03 to 0.06. The test group had a higher proportion of"excellent"subjective distance vision ratings at 1 week (50.0% vs. 36.8%, P=0.047), better comfort at 1 week and 1 month (both P<0.05), and better lens cleanliness at dispensing and 1 week (both P<0.05). Subjects with low add power had better total subjective scores at 1 week [2.0 (0.0, 4.0) vs. 4.0 (2.0, 5.0), P=0.004], with no significant difference at 3 months. At 1 month, the test group showed a smaller decrease in TBUT from baseline (P<0.05) and a higher proportion of grade 0 corneal fluorescein staining at 1 week and 1 month (both P<0.05); these differences disappeared by 3 months. No device-related serious adverse events occurred, and the incidence of adverse events did not differ significantly between groups.

The novel silicone hydrogel multifocal soft contact lens is non-inferior to the conventional hydrogel lens in presbyopia correction, with a comparable safety profile and superior comfort, subjective experience, and short-term ocular surface protection. It can serve as an effective correction option for presbyopic populations.

To explore the safety, efficacy, predictability, binocular visual balance, and postoperative visual quality of a monocular bi-aspheric ablation profile combined with laser corneal refractive surgery in patients with refractive errors associated with presbyopia, and to provide clinical evidence for individualized surgical correction of presbyopia.

This retrospective case series study included 64 patients (128 eyes) with refractive errors and presbyopia treated at Gansu Aier Eye Hospital from April 2022 to April 2026, comprising 25 males and 39 females with a mean age of (46.66±4.87) years. The dominant eye was designated for distance vision and treated with small-incision lenticule extraction (SMILE) or femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK) according to the corneal characteristics and refractive status; the non-dominant eye was designated for near vision and treated with a monocular bi-aspheric ablation profile combined with FS-LASIK, in which a certain degree of residual myopia and negative spherical aberration were intentionally induced to increase depth of focus and enhance near vision. Postoperative follow-ups were conducted at 1 day, 1 month, 3 months, and 6 months. Binocular uncorrected distance visual acuity(BUDVA), binocular uncorrected near visual acuity (BUNVA), refractive outcomes, higher-order aberrations, and subjective visual quality were evaluated.

Subgroup analysis based on dominant-eye surgical procedure showed no significant differences in postoperative binocular distance or near visual acuity between the SMILE and LASIK groups. Pooled analysis showed that BUDVA remained stable throughout follow-up and was comparable to the preoperative level, while BUNVA was significantly improved postoperatively. At 1 month postoperatively, 94.2%(49/52) of patients achieved binocular uncorrected distance visual acuity of 20/25 or better, and 80.7%(42/52) achieved 20/20 or better; meanwhile, 94.2%(49/52) achieved BUNVA of 0.8 or better, and 80.7% (42/52)achieved 1.0 or better. The median efficacy index was 1.11 (interquartile range, 1.0 to 1.2). Postoperatively, uncorrected distance visual acuity was significantly better in the dominant eye than in the non-dominant eye (P<0.001), whereas uncorrected near visual acuity was significantly better in the non-dominant eye than in the dominant eye (P=0.010), indicating successful establishment of the intended monocular bi-aspheric visual profile. At 6 months, actual spherical equivalent correlated strongly with the predicted values in both dominant and non-dominant eyes (R²=0.924 and 0.922, respectively; all P<0.001). Safety analysis showed that 90.7%(39/43) of patients had postoperative distance visual acuity that remained stable or improved, with only 9.3%(4/43) experiencing a decline; for near visual acuity, 51.2% improved by 2 or more lines and only 2.3% declined. At 6 months, the root mean square of higher-order aberrations in non-dominant eyes increased significantly compared with baseline (P=0.027), whereas spherical aberration showed a decreasing trend without statistical significance. On the subjective visual quality questionnaire, most patients reported no or only occasional visual disturbances.

The monocular bi-aspheric ablation profile combined with laser corneal refractive surgery demonstrated favorable safety, efficacy, and predictability in patients with refractive errors and presbyopia. It effectively enhanced near visual acuity while maintaining distance vision, thereby achieving binocular visual balance with good postoperative visual quality, and supporting its role as an individualized surgical approach for presbyopia correction.

To evaluate the changes of binocular visual function and patient satisfaction after small-incision lenticule extraction (SMILE) with micro-monovision in myopic patients with presbyopia.

This was a single-arm clinical trial. Myopic patients with presbyopia who underwent micro-monovision SMILE at Beijing Tongren Hospital, Capital Medical University, from January 2019 to March 2021 were enrolled. The surgical design principle was full correction of the dominant eye for distance vision, with the non-dominant eye undercorrected by -1.50 D to -0.50 D for near vision. Best corrected distance visual acuity and best corrected near visual acuity (CNVA) for the dominant eye, non-dominant eye, and both eyes were measured before surgery. Uncorrected distance and near visual acuity (UDVA, UNVA), CDVA, and CNVA for the dominant eye, non-dominant eye, and both eyes were measured at 1, 3, 6 months, 3 years, and 5 years after surgery. Accommodative function parameters were measured preoperatively and at each postoperative follow-up visit, including binocular accommodative amplitude (AMP) measured by the push-up method, accommodative response (BCC) measured by the binocular cross-cylinder method, negative relative accommodation (NRA), and positive relative accommodation (PRA), as well as distance and near stereopsis and Worth 4-dot tests. A visual satisfaction questionnaire was administered after surgery.

A total of 51 patients (102 eyes) with myopia and presbyopia were included, comprising 19 males and 32 females, aged (41.68±2.47) years. Sixteen patients (32 eyes) completed the 5-year follow-up. The binocular UDVA and UNVA were (-0.02±0.06) logMAR and (0.01±0.09) logMAR at 5 years after surgery, respectively. The spherical equivalent of the dominant and non-dominant eyes was (-0.24±0.22) D and (-0.80±0.37) D, respectively. The binocular AMP decreased from (5.66±0.28) D before surgery to (4.36±0.19) D at 1 month after surgery, and returned to the preoperative level at 3 months after surgery; The PRA decreased from (-1.93±0.17) D before surgery to (-1.33±0.13) D at 1 month after surgery, and returned to the preoperative level at 6 months after surgery. The BCC increased at 1 month after surgery and returned to the preoperative level at 6 months after surgery (differences across time points were all statistically significant, P<0.05). These indicators slightly decreased at 3 and 5 years postoperatively compared with their respective recovered levels. There were no statistically significant differences in NRA and near stereopsis at any postoperative follow-up time point compared with preoperative values. All patients achieved 60″ distance and near stereopsis at each postoperative follow-up visit point, and the Worth 4-dot tests showed both central and peripheral fusion function in both eyes. The subjective satisfaction score was (9.06±1.18) (out of 10) at 5 years after surgery, with a satisfaction rate of 15/16.

SMILE with micro-monovision had an impact on accommodative function in the early postoperative stage. The AMP, PRA, and BCC returned to preoperative levels at 3 and 6 months postoperatively, with a slight decrease at 3 to 5 years. The procedure did not affect binocular visual functions such as fusion and stereopsis. At 5 years after surgery, patients exhibited good distance and near vision, maintained binocular visual functions, and reported high subjective satisfaction.

To evaluate the visual acuity, refractive predictability, and vision-related quality of life in patients with myopia and presbyopia 3 months after laser blended vision (LBV) surgery, and to analyze factors associated with postoperative dissatisfaction.

This was a retrospective case series study. Clinical data were collected from 43 patients (86 eyes) who underwent LBV surgery for presbyopia correction at Zhongshan Ophthalmic Center, Sun Yat-sen University, from February 2025 to November 2025 and completed the postoperative 3-month follow-up. There were 21 males (48.8%) and 22 females (51.2%), with a mean age of (44.21±2.20) years. Uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) (both converted to the logarithm of the minimum angle of resolution, logMAR), manifest refraction, postoperative satisfaction scores, and the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) scores were recorded before and after surgery. Postoperative visual acuity, refractive predictability, and vision-related quality of life were analyzed. Patients were divided into a satisfied group and a dissatisfied group according to satisfaction scores. The logistic regression was used to identify factors associated with postoperative dissatisfaction, with results expressed as odds ratio (OR) and 95% confidence interval (CI).

At 3 months postoperatively, binocular UDVA and UNVA were -0.07±0.08 and 0.07±0.10, respectively. The postoperative spherical equivalent was (-0.13±0.34) D in dominant eyes and (-1.06±0.39) D in non-dominant eyes. All patients reported no need for regular presbyopia-correcting spectacles, and 32 patients (74.4%) were in the satisfied group. The scores of general vision, ocular discomfort, near activities, mental health, role difficulties, and driving in the satisfied group were significantly higher than those in the dissatisfied group (all P<0.05). Multivariate Firth-corrected logistic regression analysis showed that each 1-mm increase in axial length was associated with 3.31-fold higher odds of postoperative dissatisfaction (OR=3.31, 95%CI: 1.11-16.18, P=0.029). By contrast, elevated tear film break-up time (OR=0.74, 95%CI: 0.47-0.98, P=0.034) and elevated negative relative accommodation (OR=0.10, 95%CI: 0.01-0.51, P=0.003) were both associated with lower odds of postoperative dissatisfaction.

LBV surgery provided favorable UNVA and UDVA and good refractive predictability, with a high level of spectacle independence and overall satisfaction in patients with myopia and presbyopia. The dissatisfied patients had lower vision-related quality of life scores in near activities and role difficulties. Longer axial length was associated with an increased risk of postoperative dissatisfaction, whereas better tear film stability and greater negative relative accommodation were associated with a reduced risk, suggesting that preoperative assessment of the ocular surface status and accommodative function may be useful for patient selection and perioperative management.

To compare the subjective and objective visual outcomes after implantation of monofocal, bifocal, and extended depth-of-focus (EDOF) intraocular lenses (IOLs).

This non-randomized controlled clinical trial enrolled cataract patients scheduled for phacoemulsification and IOL implantation at Beijing Tongren Eye Center, Capital Medical University, between April and December 2025. According to the implanted IOL type, patients were assigned to monofocal, bifocal, diffractive EDOF, and non-diffractive EDOF groups. Visual acuity, defocus curves, objective visual quality, and the Visual Function Index-14 (VF-14) questionnaire were evaluated at 3 months postoperatively. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), and distance-corrected near visual acuity (DCNVA) were measured and recorded in logarithm of the minimum angle of resolution (logMAR). Defocus curves were obtained from +1.00 to -4.00 D in 0.50-D steps under best distance correction. Intraocular wavefront aberrations and modulation transfer function (MTF) were measured at a 4.0-mm pupil diameter using an optical path difference-based aberrometer. Objective scatter index, MTF cut-off frequency, and Strehl ratio (SR) were assessed using a double-pass optical quality analysis system. Intergroup comparisons were performed using one-way analysis of variance or the Kruskal-Wallis H test with Bonferroni post hoc correction. Pearson correlation analysis and linear regression models were used to identify factors associated with intraocular higher-order aberrations (HOAs).

A total of 67 patients (67 eyes) were enrolled. Except three patients lost to follow-up and one patient incomplete data, 63 patients (63 eyes) were included in the analysis, with 15 eyes in the monofocal group, 17 eyes in the bifocal group, 14 eyes in the diffractive EDOF group, and 17 eyes in the non-diffractive EDOF group. The mean age was (67.24±6.85) years. There were 17 men and 46 women. Baseline characteristics were comparable among the four groups (all P>0.05). At 3 months postoperatively, UDVA did not differ significantly among the groups (P=0.054). The bifocal group achieved the best CDVA (-0.02±0.07), which was significantly better than that of the monofocal group (0.07±0.09) and the diffractive EDOF group (0.05±0.05) (P=0.033). The bifocal group also demonstrated significantly higher MTF cut-off frequency and SR than the monofocal and non-diffractive EDOF groups (both P<0.05). Both EDOF groups showed significantly better DCIVA than the monofocal and bifocal groups (both P<0.001). On defocus curve analysis, the diffractive EDOF group maintained visual acuity of 0.2 logMAR or better within a defocus range of up to -2.00 D, whereas the non-diffractive EDOF group maintained this level within -1.50 D. The monofocal group exhibited the poorest DCNVA (0.60±0.23), while no significant difference was observed among the other three groups. Postoperative spherical equivalent refraction was close to emmetropia in the monofocal [(-0.15±0.44) D] and bifocal [(0.12±0.37) D] groups, whereas mild myopia was observed in the diffractive EDOF [(-0.73±0.41) D] and non-diffractive EDOF [(-0.63±0.51) D] groups (P<0.001). The spherical aberration was significantly higher in the non-diffractive EDOF group than in the other three groups (all P<0.05). Nevertheless, this group achieved the highest VF-14 score and showed better performance in night driving and fine handwork tasks. Correlation and regression analyses demonstrated that the MTF cut-off and SR were independently associated with intraocular HOAs.

EDOF IOLs provided superior intermediate visual acuity and a broader continuous functional range of vision. The non-diffractive EDOF group showed a trend toward better subjective visual function, although VF-14 scores did not differ significantly among the four groups. Bifocal IOLs demonstrated superior objective optical performance. Selection of IOLs should be individualized according to the functional visual range, optical quality, and patient-specific visual demands.

A 79-year-old female patient was admitted to the hospital due to bilateral progressive visual acuity loss for more than 1 year. She had a history of hypertension, facial paralysis and ocular surgery. Through ophthalmic examination, ultrasound biomicroscopy and anterior segment optical coherence tomography, she was diagnosed with bilateral senile nuclear cataract and bilateral true lens capsule exfoliation. Subsequently, she underwent bilateral phacoemulsification combined with intraocular lens implantation. Pathological examination of the anterior lens capsule peeled off during surgery confirmed the presence of epithelial cell loss and defect, double-layer separation, pigment deposition and other changes.

A 70-year-old male patient presented to Wuhan Aige Eye Hospital with a 1-month history of redness, pain, decreased vision in the right eye, and the pain was aggravated at night. Examination revealed multiple nodular scleral abscesses. After incision and drainage, nanopore targeted sequencing of the specimens identified Aspergillus flavus as the pathogen. The patient was diagnosed with fungal scleritis (scleral abscess) of the right eye. Susceptibility-guided systemic and topical antifungal therapy was administered for one month, leading to complete recovery. No recurrence was observed during the 5 months of follow-up.

The patient was a 73-year-old female. Because of itching in both eyes for 1 month, he went to the Department of Ophthalmology, the First Hospital of Jilin University. Past physical fitness. Eye examination: Several needle-like reddish-brown adults crawled slowly at the eyelashes of both eyelids, with yellow scab shells and a large number of white suspected egg attachments at the roots of the eyelashes; The conjunctiva of both eyes was mildly congested, the cornea was transparent, the fluorescein was scattered in dots, and other ocular examinations were roughly normal.

The patient was a 50-year-old male. He went to the Eye Hospital affiliated to Shandong First Medical University because of red left eye and visual acuity decrease for 7 days. The patient had poor visual acuity in the left eye since childhood. The whole body examination showed no obvious abnormalities. Eye examination: Left eye visual acuity was light sensing (uncorrectable), red-green light color vision (-), intraocular pressure was 56 mmHg (1 mmHg =0.133 kPa), mixed conjunctiva hyperemia, corneal fog edema, disappearance of anterior chamber, iris atrophy, unclear texture, dilated pupil, about 8 mm in diameter, response to light (-), extreme advancement and expansion of the lens, incomplete dislocation, brown-black grade V nucleus, invisible fundus (essence picture 1); The axial length was 23.43 mm for the right eye and 27.35 mm for the left eye. Panoramic coherence light tomography examination: the left eye lens is extremely expanded, the central anterior chamber disappears, and the angle of the chamber is closed (Quintessential Picture 2). In vivo confocal microscopy: corneal endothelial cell count was approximately 960/mm²。 Clinical diagnosis: left eye incomplete lens dislocation, complicated cataract, secondary glaucoma; High myopia in the left eye.

Presbyopia is a common age-related disorder characterized by a progressive decline in ocular accommodative function, primarily manifesting as reduced near visual acuity. Traditionally, it has been attributed to lens sclerosis. Recent molecular biological studies have elucidated the core mechanisms underlying lens sclerosis from the perspectives of oxidative stress, cytoskeletal remodeling, and activation of mechanically sensitive ion channels. In addition, emerging biomechanical imaging technologies such as optical coherence elastography and Brillouin microscopy have provided novel tools for the quantitative assessment of biomechanical properties of the lens and intraocular tissues. Concurrently, declining ciliary body function, scleral stiffening, aqueous humor-vitreous system homeostatic imbalance, and age-related degeneration of the visual nervous system collectively highlight the multifactorial nature of presbyopia. This review summarizes recent advances in understanding the mechanisms of presbyopia development, aiming to provide insights for both clinical practice and basic research.

Keratoconus (KCN) is a progressive corneal ectasia disorder characterized by thinning and steepening of the cornea. Intraocular lens (IOL) power calculation in cataract patients with KCN often leads to a significant hyperopic prediction error. This is attributable to several factors, including inaccurate keratometry, an altered anterior-to-posterior corneal curvature ratio and erroneous prediction of the effective lens position (ELP). Recent studies have shown that KCN-specific formulas such as the Barrett True-K (BTK) formula and the Kane KCN formula can significantly improve refractive prediction accuracy. This review examines the influence of KCN on IOL power calculations, evaluates the performance of previous formulas in cataract patients with KCN, discusses formula selection strategies based on KCN severity, and systematically summarizes the latest research progress in IOL power calculation, astigmatism correction and IOL power calculation after collagen cross-linking (CXL) for these patients.

Neurotrophic keratopathy (NK) is a rare degenerative corneal disease characterized by impaired corneal sensory innervation, which results in epithelial defects and the development of corneal ulcers. This condition frequently progresses to severe complications. Given the limited efficacy of conventional therapies, topical insulin eye drop treatment has emerged as a promising approach in NK management due to its distinctive mechanism and substantial effectiveness in promoting corneal healing. Extensive research has demonstrated that insulin plays a critical role in corneal tissue repair via multi-target and multi-pathway molecular mechanisms. The topical administration of insulin eye drops significantly accelerates the healing of refractory neurotrophic epithelial defects and corneal ulcers. Due to its high safety profile, ease of preparation, and remarkable therapeutic outcomes, insulin eye drops represent a valuable and reliable treatment option for patients with refractory corneal diseases.

Nystagmus is a common and challenging ophthalmic disorder characterized by involuntary, rhythmic, to-and-fro or jerky oscillations of the eyes. Its etiology is complex, and it severely affects patients′ visual quality and quality of life. In recent years, with the rapid development of neuro-ophthalmology, genetics, and imaging technologies, significant progress has been made both domestically and internationally in understanding the pathophysiological mechanisms, refined diagnostic classification, and diversified treatment strategies for nystagmus. Based on previous expert consensus, research literature, and the latest evidence-based medical evidence, this article summarizes the classification criteria, examination and diagnostic methods, and treatment principles and strategies for nystagmus, and discusses the application prospects and research directions of emerging diagnostic and therapeutic techniques, aiming to provide a practical reference for clinical work in ophthalmology and related disciplines.