Clinical feasibility of pinhole glasses in presbyopia

Purpose:To investigate the ocular physiologic changes and subjective symptoms of wearing multiple-pinhole glasses in subjects with presbyopia.Methods:This prospective study included 32 eligible subjects with presbyopia. Objective ocular functions and a survey of ocular discomfort were performed at baseline. All participants underwent the same examinations after reading while wearing the pinhole glasses and not wearing these glasses at a 1-week interval in random order.Results:The pinhole glasses improved uncorrected distance and near visual acuity in presbyopia. These glasses also required 15% less accommodative power over the near stimulus of 25 cm than did eyes without pinholes. Compared to reading without pinhole glasses, reading with pinhole glasses led to the following changes: increase in monocular near point of accommodation from 4.39 ± 0.78 diopter (D) to 5.19 ± 1.12 D, increase in depth of focus from 1.42 ± 0.44 D to 2.00 ± 0.33 D, and increase in amplitude of fusional convergence from 13.38 ± 6.88 prism D to 21.62 ± 10.00 prism D. In contrast, the reading speed decreased, inter-blink interval increased, tear break-up time shortened, and subjective ophthalmic symptoms worsened with pinhole glasses compared to without.Conclusion:In presbyopia, pinhole glasses improve visual acuity and accommodation-related parameters by pseudo-accommodation and the pinhole effect. However, the low legibility, increased inter-blink interval, and shortened break-up time of pinhole glasses cause an uncomfortable feeling and excessive eye fatigue. Pinhole glasses have strengths and limitations that must be considered to provide appropriate guidance in patients with presbyopia. Clinical trial registration was done at www.ClinicalTrials.gov (identifier: NCT02722291).