Lorne Bellan, MD, Chairman, Department of Ophthalmology, University of Manitoba, Winnipeg, MB.

Cataract surgery is the most common refractive surgical procedure performed on aging individuals. Major advancements in surgical and lens technology have led to enormous increases in surgical volume because of the improved safety profile and outcomes. Current research holds the potential for restoring full vision, including accommodation, without the need for glasses in the near future.
Key words: cataract, lens, refractive, vision, phacoemulsification.

Jie Jin Wang, MMed, PhD, Centre for Vision Research, Department of Ophthalmology, Westmead Millennium Institute, University of Sydney, Australia.
Jennifer L. Smith, BA, PhD, Australian Health Policy Institute, University of Sydney, Australia.
Stephen R. Leeder, BSc (Med), MB, PhD, Australian Health Policy Institute, University of Sydney, and The Menzies Centre for Public Health Policy, Australia.

Vision and hearing impairments are common in older people. They not only impact on the quality of life and independent living of affected individuals, but also contribute to the overall burden of aged care. Although current evidence supports screening for age-related vision and/or hearing impairments, good- quality evidence on the effectiveness of sensory interventions (e.g., treatment for eye conditions or rehabilitation for hearing loss) is lacking. Evidence from community-based randomized controlled trials is needed before implementing community-wide screening. Case-finding during primary health care can be considered. Strategies to reduce the overall burden from common disabilities, including sensory impairments, among older people are keys to achieving the goal of “aging well, aging productively.”
Key words: aging, screening, vision, hearing, sensory impairment.

Physiological Aging Occurs throughout the Eye and can bring about the Loss of Vision

Cindy M.L. Hutnik, MD, PhD, FRCSC
Department of Ophthalmology,
University of Western Ontario
Active Staff, St. Joseph's Health Centre, London, ON

Introduction
In 1942, Sir W. Stewart Duke-Elder published his classic ophthalmic text series.¹ The first paragraph eloquently describes his thoughts on the genesis of vision and the evolution of the eye "from remote and lowly origins, far removed in form and in function from the highly specialized mechanism we find in man; indeed, it is no easy matter to decide where its origin lay or when the sense of vision first became a factor in conscious behaviour." He begins by stating that "either in fact or in fiction there are few stories more fascinating than the history of the evolution of the visual apparatus from primitive undifferential protoplasm into a system of the highest delicacy and intricacy of structure." Recognizing the complexity of the human eye, the following is a summary of how this intricate structure withstands the physiological stresses of a normal human life span.

The eye is not exempt from the relentless process of aging. Structurally, changes can be observed in all parts of the eye, both macroscopically and microscopically. The key is to recognize when these structural changes begin to threaten function.

Kim Wilson, BSc, MSc

Cataract patients may now choose to have a multifocal implantable lens which corrects for distance, intermediate and near vision. During surgery, the patient's cataract or cloudy crystalline lens is removed and replaced by the foldable multifocal lens which then unfolds once positioned in the eye.

"This lens is significant to the elderly", said Dr. Allan Slomovic, Clinical Director of the Cornea and External Ocular Diseases at the Toronto Hospital (Western Division), and the Program Director in the Department of Ophthalmology at the University of Toronto. Dr. Slomovic is one of eleven ophthalmologists originally performing this surgery in Canada, and he says "this foldable lens allows for a very small incision of about 3.2 mm, which allows the eye to heal faster and the patient recovers their vision quickly."

Other foldable lenses are available, but the multifocal lens has the added advantage of correcting for distance, intermediate and near vision. The multifocal lens has a series of zones with different refractive powers, allowing the patient to see a range of distances. Each zone has different refractive powers, with zones one, three and five allowing the eyes to focus on objects at a distance, while zones two and four allow focusing of near objects.

The multifocal lens was developed by Allergan Inc. in California.