Introduction by Vittorio Picardo

Tidying up my bookshelf a few days ago, I came across Amar Agarwal's monograph 'Presbyopia. A Surgical textbook' from 2002, a text from about 10 years ago.

In this interesting and comprehensive volume, for that time, the problem of correcting presbyopia was addressed in four separate sections, one of which was introductory, and the others devoted to numerous surgical options.

The second section of the text contained proposals for scleral surgery, with expanders or implants, laser treatment with infrared and titanium implants on sclerotomy.

The next one, the third, enumerated the possibilities of correction with corneal treatments, such as laser with PARM option or other laser treatments with both thermokeratoplasty and conductive keratoplasty techniques; finally, there is a contribution with the proposal of a monovision, again produced with unilateral lasik treatment.

Finally, in the last chapter, of 50 pages in all, tenuous and timid proposals for lens surgery were introduced, using the first models of accommodative IOLs or, according to other authors, multifocal lenses or presbyopic anterior chamber lenses.
In short, endocular surgery, especially on the lens, was the youngest, most uncertain, least practised option.

All these techniques, which Agarwal reports in his monograph, availing himself of the collaboration of so many illustrious Colleagues from all continents, from the Americas and South America, to Europe, India, and even Eastern countries such as Japan, have only lasted the space of a morning, because as the Researchers have applied them to their personal case histories, they have shown their limitations, risks, and complications.

And it was not acceptable, then as now, to operate on eyes that were functionally healthy, because they were in keeping with the patient's presbyopic age, without achieving significant improvements in the quality and quantity of vision and above all without substantially improving the patient's compliance.

Recently, however, there have been some important developments in the field of instrumental diagnostics and technology in eye surgery: - the introduction of new semeiotics equipment, such as aberrometers - the exponential increase in the quality and safety factor in ultrasound cataract surgery, with the use of 'intelligent' phaco units - the slow but inexorable advancement of the femtolaser for cataracts - the ever-widening range of premium, accommodative, multifocal and toric IOLs with aspheric surfaces and filter treatments.

All these elements have greatly shifted the eye surgeon's attention to the world of endocular surgery, foregoing scleral or corneal techniques in an attempt to produce presbyopia correction through lens replacement in both eyes, with a wide choice of criteria resulting in different optical functional solutions (treatment customisation).

There has long been talk of monovision, accommodative IOLs, refractive and diffractive multifocals, the Mix&Match technique, and perhaps other solutions are already in the pipeline or just around the corner.

Moreover, the 'wear and tear of modern life', as an old TV commercial used to say, leads us to want, always and at any age, to demand the best performance from our organism in all fields, from the sense organs to other moments of life.

Finally, the structuring of a working day still involves the use of a car, a computer, our smartphone, not forgetting perhaps a trip to the gym, the swimming pool or the tennis court.

Being able to do all this while carrying almost no optical accessories is now the gold standard of our consumerist and hedonistic society, much more devoted to appearance than substance.

But the latter option is not acceptable in the medical field, where substance means a clinico-functional result, it means respect for the patient, it means having assessed and prepared the clinical case well, and having addressed and resolved it in the best possible way.

This monograph, which adds to the others already published by 'l'Oculista italiano', aims to respect this professional philosophy by studying in detail a topic of great topical interest such as the treatment of presbyopia.

The book is structured according to the latest clinical research, in the light of the latest developments in diagnostic and surgical devices, in order to provide us ophthalmologists with a complete and comprehensive overview.

The reader will thus have an improvement in his cultural education, on a subject that is indeed much debated, both in Italy and abroad. The authoritativeness and competence of the Authors of the various chapters, all qualified Colleagues, but mainly Friends, has allowed, not so much myself, but the Editors in the person of Ada Puglisi to coordinate and realise a volume of great scientific value, with an organisational effort that has certainly been facilitated by the quality of the material collected.

Finally, I think that all of us readers should thank Carmelo Chines, who with tenacity and determination wanted to produce this additional monograph.

SIFI, the publisher of the magazine, today confirms itself with intelligence and foresight as a leading company in the field of pharmacology and production of ophthalmic products.
Within this reality, consolidated by about 80 years of history, a new company called Sifi Medtech was set up a few years ago, completely dedicated to the design, development, production and marketing, both nationally and internationally, of medical-surgical devices and diagnostic instruments for cataract surgery. With reference to the topic addressed in this volume, SIFI Medtech is currently engaged in the development of innovative devices with the aim of improving the patient's quality of life and offering the surgeon highly performing therapeutic choices free from side effects.

Commitment, effort and enthusiasm were the energy that moved the Authors and Editorial Staff. An enjoyable reading and a broadening of our knowledge is the aim of this further SIFI Monograph.

Vittorio Picardo
Scientific coordinator