<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.3 20210610//EN" "JATS-journalpublishing1-3.dtd">
<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">ophthalmology</journal-id><journal-title-group><journal-title xml:lang="ru">Офтальмология</journal-title><trans-title-group xml:lang="en"><trans-title>Ophthalmology in Russia</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1816-5095</issn><issn pub-type="epub">2500-0845</issn><publisher><publisher-name>Ophthalmology</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.18008/1816-5095-2024-3-617-622</article-id><article-id custom-type="elpub" pub-id-type="custom">ophthalmology-2444</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>HEALTH CARE</subject></subj-group></article-categories><title-group><article-title>Дисфункциональные изменения хрусталика в реальной клинической практике</article-title><trans-title-group xml:lang="en"><trans-title>Dysfunctional Changes in the Lens in Real Clinical Practice</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-6311-5452</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Фурсова</surname><given-names>А. Ж.</given-names></name><name name-style="western" xml:lang="en"><surname>Fursova</surname><given-names>A. Zh.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Фурсова Анжела Жановна - доктор медицинских наук, заведующая офтальмологическим отделением Новосибирской областной клинической больницы, главный офтальмолог Новосибирской области и главный детский офтальмолог Новосибирской области.</p><p>Ул. Немировича­Данченко, 130, Новосибирск, 630087</p></bio><bio xml:lang="en"><p>Fursova Angela Z. - MD, head of the Ophthalmological Department of the Novosibirsk Regional Clinical Hospital, chief ophthalmologist of the Novosibirsk region and chief pediatric ophthalmologist of the Novosibirsk Region.</p><p>Nemirovich­Danchenko str., 130, Novosibirsk, 630087</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0057-3338</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Лоскутов</surname><given-names>И. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Loskutov</surname><given-names>I. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Лоскутов Игорь Анатольевич - доктор медицинских наук, заведующий научным отделом и кафедрой офтальмологии и оптометрии, главный офтальмолог Московской области, руководитель офтальмологической службы.</p><p>129110, Москва, ул. Щепкина, 61/2, Москва, 129110</p></bio><bio xml:lang="en"><p>Loskutov Igor A. - MD, ophthalmologist, head of the Scientific Department and Department of Ophthalmology and Optometry, chief ophthalmologist of the Moscow Region, head of the Ophthalmological Service.</p><p>Shchepkina str., 61/2, Moscow, 129110</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0009-0005-2783-9935</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Борисов</surname><given-names>Ф. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Borisov</surname><given-names>F. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Борисов Федор Григорьевич - ординатор 2­го года обучения.</p><p>129110, г. Москва, ул. Щепкина, 61/2, Москва, 129110</p></bio><bio xml:lang="en"><p>Borisov Fedor G. - resident</p><p>Shchepkina str., 61/2, Moscow, 129110</p></bio><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ГБУЗ Новосибирской области «Государственная Новосибирская областная клиническая больница»; ФГБОУ ВО «Новосибирский государственный медицинский университет» Министерства здравоохранения Российской Федерации</institution><country>Россия</country></aff><aff xml:lang="en"><institution>State Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Moscow Regional Research Clinical Institute named after M.F. Vladimirsky</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>03</day><month>10</month><year>2024</year></pub-date><volume>21</volume><issue>3</issue><fpage>617</fpage><lpage>622</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Фурсова А.Ж., Лоскутов И.А., Борисов Ф.Г., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Фурсова А.Ж., Лоскутов И.А., Борисов Ф.Г.</copyright-holder><copyright-holder xml:lang="en">Fursova A.Z., Loskutov I.A., Borisov F.G.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.ophthalmojournal.com/opht/article/view/2444">https://www.ophthalmojournal.com/opht/article/view/2444</self-uri><abstract><sec><title>Введение</title><p>Введение. Пресбиопия является глобальной проблемой, затрагивающей более 1,5 миллиарда человек по всему миру. Прогнозы указывают на увеличение среднего возраста населения к 2050 году до 40 лет с соответствующим увеличением случаев пресбиопии и сопутствующими экономическими потерями. Несмотря на повсеместное распространение пресбиопии, в настоящее время не существует эффективных способов ранней профилактики и восстановления динамической аккомодации и стандартизированного подхода к оценке возрастных изменений хрусталика, лежащих в основе пресбиопии. Целью данного исследования является изучение влияния возрастных изменений хрусталика на аккомодацию и рассмотрение современных фармакологических подходов к профилактике и лечению пресбиопии.</p></sec><sec><title>Методы</title><p>Методы. Проведено многоцентровое проспективное исследование, включающее анализ остроты зрения, ближайшей точки ясного зрения и объема аккомодации у лиц в возрасте от 40 до 55 лет. Участникам исследования назначали пиреноксин (Каталин) в виде глазных капель 3 раза в день на протяжении 4 месяцев. Исследование включило 382 анкеты, собранные от 29 офтальмологов.</p></sec><sec><title>Результаты</title><p>Результаты. В результате исследования среднее расстояние до ближайшей точки ясного зрения незначительно уменьшилось, а запас аккомодации остался на прежнем уровне. Это свидетельствует об отсутствии значительного прогрессирования возрастного уменьшения запаса аккомодации как одного из проявлений пресбиопии и возможной эффективности пиреноксина в сохранении эластичных свойств хрусталика.</p></sec><sec><title>Заключение</title><p>Заключение. Исследование подтвердило эффективность пиреноксина в профилактике пресбиопии и сохранении аккомодационных возможностей у людей среднего возраста. Понятие «синдром дисфункции хрусталика» (Dysfunctional Lens Syndrome) может быть полезным для клинической практики, предоставляя возможности для ранней диагностики и лечения пресбиопии. Включение этого понятия в клинические рекомендации может улучшить подходы к лечению и профилактике возрастных изменений хрусталика.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Introduction</title><p>Introduction. Presbyopia is a global problem affecting more than 1.5 billion people worldwide. Projections indicate an increase in the average age of the population to 40 years by 2050, which is associated with an increase in the presbyopia incidence and corresponding economic losses. Despite the widespread prevalence of presbyopia, there are currently no effective methods for early prevention and restoration of dynamic accommodation and a standardized approach to assessing age-related changes in the lens that underlie presbyopia. The purpose: to study the effect of age-related changes in the lens on accommodation and to consider modern pharmacological approaches to the prevention and treatment of presbyopia.</p></sec><sec><title>Methods</title><p>Methods. A multicenter prospective study was conducted, including analysis of visual acuity, the nearest point of clear vision and the volume of accommodation in individuals aged 40 to 55 years. Study participants were prescribed pyrenoxine (Catalin) as eye drops three times daily for 4 months. The study included 382 questionnaires collected from 29 ophthalmologists.</p></sec><sec><title>Results</title><p>Results. As a result of the study, the average distance to the nearest point of clear vision decreased slightly, but the reserve of accommodation remained at the same level. This indicates the absence of significant progression of age-related decrease in the reserve of accommodation as one of the manifestations of presbyopia and the possible effectiveness of pyrenoxine in preserving the elastic properties of the lens.</p></sec><sec><title>Conclusion</title><p>Conclusion. The study confirmed the effectiveness of pyrenoxine in the prevention of presbyopia and the preservation of accommodative abilities in middle-aged people. The concept of Dysfunctional Lens Syndrome may be useful for clinical practice by providing opportunities for early diagnosis and treatment of presbyopia. Incorporating this concept into clinical guidelines may improve approaches to the treatment and prevention of age-related lens changes.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>синдром дисфункции хрусталика</kwd><kwd>объем аккомодации</kwd><kwd>пиреноксин</kwd><kwd>пресбиопия</kwd><kwd>катаракта</kwd></kwd-group><kwd-group xml:lang="en"><kwd>lens dysfunction syndrome</kwd><kwd>volume of accommodation</kwd><kwd>pyrenoxine</kwd><kwd>presbyopia</kwd><kwd>cataract</kwd></kwd-group><funding-group><funding-statement xml:lang="ru">Благодарность за участие в исследовании врачам-офтальмологам: Бондаренко Н.Н., Чернецкой И.И., Цой В.В., Добровецкой С.С., Порниной Е.А., Манукян Г.А., Чередниченко О.Г., Филимоновой В.В., Бесултановой Х.Х., Яровкиной Л.Ю., Бугуловой Л.М., Новиковой Т.А., Рытик Н.П., Гречаниченко Н.А., Олейникову К.Е., Артишевской С.А., Мартыненко Д.И., Чикановой А.Н., Костиной Н.Е., Романенковой С.А., Островской О.В., Головиной Н.В., Борисовой О.В., Шаповаловой Ж.Б., Таджиевой З.А., Ковтуновой Т.Ю., Стригуновой Е.Б., Аскернаджад С.Р., Камаха М.В.</funding-statement></funding-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Ke­ effe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Resnikoff S, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta­analysis. Lancet Glob Health. 2017 Sep;5(9):e888–e897. doi: 10.1016/S2214­109X(17)30293­0.</mixed-citation><mixed-citation xml:lang="en">Bourne RRA, Flaxman SR, Braithwaite T, Cicinelli MV, Das A, Jonas JB, Ke­ effe J, Kempen JH, Leasher J, Limburg H, Naidoo K, Pesudovs K, Resnikoff S, Silvester A, Stevens GA, Tahhan N, Wong TY, Taylor HR; Vision Loss Expert Group. Magnitude, temporal trends, and projections of the global prevalence of blindness and distance and near vision impairment: a systematic review and meta­analysis. Lancet Glob Health. 2017 Sep;5(9):e888–e897. doi: 10.1016/S2214­109X(17)30293­0.</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Vargas V, Vejarano F, Alió JL. Near Vision Improvement with the Use of a New Top­ ical Compound for Presbyopia Correction: A Prospective, Consecutive Interven­ tional Non­Comparative Clinical Study. Ophthalmol Ther. 2019 Mar;8(1):31–39. doi: 10.1007/s40123­018­0154­6.</mixed-citation><mixed-citation xml:lang="en">Vargas V, Vejarano F, Alió JL. Near Vision Improvement with the Use of a New Top­ ical Compound for Presbyopia Correction: A Prospective, Consecutive Interven­ tional Non­Comparative Clinical Study. Ophthalmol Ther. 2019 Mar;8(1):31–39. doi: 10.1007/s40123­018­0154­6.</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Cheng F, Shan L, Song W, Fan P, Yuan H. Distance­ and near­visual impair­ ment in rural Chinese adults in Kailu, Inner Mongolia. Acta Ophthalmol. 2016 Jun;94(4):407–413. doi: 10.1111/aos.12808.</mixed-citation><mixed-citation xml:lang="en">Cheng F, Shan L, Song W, Fan P, Yuan H. Distance­ and near­visual impair­ ment in rural Chinese adults in Kailu, Inner Mongolia. Acta Ophthalmol. 2016 Jun;94(4):407–413. doi: 10.1111/aos.12808.</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Frick KD, Joy SM, Wilson DA, Naidoo KS, Holden BA. The Global Burden of Potential Productivity Loss from Uncorrected Presbyopia. Ophthalmology. 2015 Aug;122(8):1706–1710. doi: 10.1016/j.ophtha.2015.04.014.</mixed-citation><mixed-citation xml:lang="en">Frick KD, Joy SM, Wilson DA, Naidoo KS, Holden BA. The Global Burden of Potential Productivity Loss from Uncorrected Presbyopia. Ophthalmology. 2015 Aug;122(8):1706–1710. doi: 10.1016/j.ophtha.2015.04.014.</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Donaldson KE. The Economic Impact of Presbyopia. J Refract Surg. 2021 Jun; 37(S1):S17–S19. doi: 10.3928/1081597X­20210408­03.</mixed-citation><mixed-citation xml:lang="en">Donaldson KE. The Economic Impact of Presbyopia. J Refract Surg. 2021 Jun; 37(S1):S17–S19. doi: 10.3928/1081597X­20210408­03.</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Wolffsohn JS, Davies LN. Presbyopia: Effectiveness of correction strategies. Prog Retin Eye Res. 2019 Jan;68:124–143. doi: 10.1016/j.preteyeres.2018.09.004.</mixed-citation><mixed-citation xml:lang="en">Wolffsohn JS, Davies LN. Presbyopia: Effectiveness of correction strategies. Prog Retin Eye Res. 2019 Jan;68:124–143. doi: 10.1016/j.preteyeres.2018.09.004.</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Girum M, Desalegn Gudeta A, Shiferaw Alemu D. Determinants of high unmet need for presbyopia correction: a community­based study in northwest Ethiopia. Clin Optom (Auckl). 2017 Jan 23;9:25–31. doi: 10.2147/OPTO.S123847.</mixed-citation><mixed-citation xml:lang="en">Girum M, Desalegn Gudeta A, Shiferaw Alemu D. Determinants of high unmet need for presbyopia correction: a community­based study in northwest Ethiopia. Clin Optom (Auckl). 2017 Jan 23;9:25–31. doi: 10.2147/OPTO.S123847.</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Abdelkader A, Kaufman HE. Clinical outcomes of combined versus separate car­ bachol and brimonidine drops in correcting presbyopia. Eye Vis (Lond). 2016 Dec 5;3:31. doi: 10.1186/s40662­016­0065­3.</mixed-citation><mixed-citation xml:lang="en">Abdelkader A, Kaufman HE. Clinical outcomes of combined versus separate car­ bachol and brimonidine drops in correcting presbyopia. Eye Vis (Lond). 2016 Dec 5;3:31. doi: 10.1186/s40662­016­0065­3.</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Hookway LA, Frazier M, Rivera N, Ramson P, Carballo L, Naidoo K. Population­ based study of presbyopia in Nicaragua. Clin Exp Optom. 2016 Nov;99(6):559–563. doi: 10.1111/cxo.12402.</mixed-citation><mixed-citation xml:lang="en">Hookway LA, Frazier M, Rivera N, Ramson P, Carballo L, Naidoo K. Population­ based study of presbyopia in Nicaragua. Clin Exp Optom. 2016 Nov;99(6):559–563. doi: 10.1111/cxo.12402.</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Fisher RF. Presbyopia and the changes with age in the human crystalline lens. J Physiol. 1973 Feb;228(3):765–779. doi: 10.1113/jphysiol.1973.sp010111.</mixed-citation><mixed-citation xml:lang="en">Fisher RF. Presbyopia and the changes with age in the human crystalline lens. J Physiol. 1973 Feb;228(3):765–779. doi: 10.1113/jphysiol.1973.sp010111.</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Atchison DA, Blazaki S, Suheimat M, Plainis S, Charman WN. Do small­aper­ ture presbyopic corrections influence the visual field? Ophthalmic Physiol Opt. 2016 Jan;36(1):51–59. doi: 10.1111/opo.12265.</mixed-citation><mixed-citation xml:lang="en">Atchison DA, Blazaki S, Suheimat M, Plainis S, Charman WN. Do small­aper­ ture presbyopic corrections influence the visual field? Ophthalmic Physiol Opt. 2016 Jan;36(1):51–59. doi: 10.1111/opo.12265.</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Kasthurirangan S, Markwell EL, Atchison DA, Pope JM. MRI study of the changes in crystalline lens shape with accommodation and aging in humans. J Vis. 2011 Mar 25;11(3):19. doi: 10.1167/11.3.19.</mixed-citation><mixed-citation xml:lang="en">Kasthurirangan S, Markwell EL, Atchison DA, Pope JM. MRI study of the changes in crystalline lens shape with accommodation and aging in humans. J Vis. 2011 Mar 25;11(3):19. doi: 10.1167/11.3.19.</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Richdale K, Bullimore MA, Sinnott LT, Zadnik K. The Effect of Age, Accommodation, and Refractive Error on the Adult Human Eye. Optom Vis Sci. 2016 Jan;93(1):3–11. doi: 10.1097/OPX.0000000000000757.</mixed-citation><mixed-citation xml:lang="en">Richdale K, Bullimore MA, Sinnott LT, Zadnik K. The Effect of Age, Accommodation, and Refractive Error on the Adult Human Eye. Optom Vis Sci. 2016 Jan;93(1):3–11. doi: 10.1097/OPX.0000000000000757.</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Chang CK, Wang SS, Lo CH, Hsiao HC, Wu JW. Investigation of the early stages of hu­ man γD­crystallin aggregation process. J Biomol Struct Dyn. 2017 Apr;35(5):1042– 1054. doi: 10.1080/07391102.2016.1170632.</mixed-citation><mixed-citation xml:lang="en">Chang CK, Wang SS, Lo CH, Hsiao HC, Wu JW. Investigation of the early stages of hu­ man γD­crystallin aggregation process. J Biomol Struct Dyn. 2017 Apr;35(5):1042– 1054. doi: 10.1080/07391102.2016.1170632.</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Khan A, Pope JM, Verkicharla PK, Suheimat M, Atchison DA. Change in human lens dimensions, lens refractive index distribution and ciliary body ring diameter with accommodation. Biomed Opt Express. 2018 Feb 21;9(3):1272–1282. doi: 10.1364/BOE.9.001272.</mixed-citation><mixed-citation xml:lang="en">Khan A, Pope JM, Verkicharla PK, Suheimat M, Atchison DA. Change in human lens dimensions, lens refractive index distribution and ciliary body ring diameter with accommodation. Biomed Opt Express. 2018 Feb 21;9(3):1272–1282. doi: 10.1364/BOE.9.001272.</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Horwitz J. Alpha­crystallin can function as a molecular chaperone. Proc Natl Acad Sci U S A. 1992 Nov 1;89(21):10449–10453. doi: 10.1073/pnas.89.21.10449.</mixed-citation><mixed-citation xml:lang="en">Horwitz J. Alpha­crystallin can function as a molecular chaperone. Proc Natl Acad Sci U S A. 1992 Nov 1;89(21):10449–10453. doi: 10.1073/pnas.89.21.10449.</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Upaphong P, Thonusin C, Choovuthayakorn J, Chattipakorn N, Chattipakorn SC. The Possible Positive Mechanisms of Pirenoxine in Cataract Formation. Int J Mol Sci. 2022 Aug 21;23(16):9431. doi: 10.3390/ijms23169431.</mixed-citation><mixed-citation xml:lang="en">Upaphong P, Thonusin C, Choovuthayakorn J, Chattipakorn N, Chattipakorn SC. The Possible Positive Mechanisms of Pirenoxine in Cataract Formation. Int J Mol Sci. 2022 Aug 21;23(16):9431. doi: 10.3390/ijms23169431.</mixed-citation></citation-alternatives></ref><ref id="cit18"><label>18</label><citation-alternatives><mixed-citation xml:lang="ru">Glasser A, Kaufman PL. The mechanism of accommodation in primates. Ophthal­ mology. 1999 May;106(5):863–872. doi: 10.1016/S0161­6420(99)00502­3.</mixed-citation><mixed-citation xml:lang="en">Glasser A, Kaufman PL. The mechanism of accommodation in primates. Ophthal­ mology. 1999 May;106(5):863–872. doi: 10.1016/S0161­6420(99)00502­3.</mixed-citation></citation-alternatives></ref><ref id="cit19"><label>19</label><citation-alternatives><mixed-citation xml:lang="ru">Weeber HA, Eckert G, Pechhold W, van der Heijde RG. Stiffness gradient in the crystalline lens. Graefes Arch Clin Exp Ophthalmol. 2007 Sep;245(9):1357–1366. doi: 10.1007/s00417­007­0537­1.</mixed-citation><mixed-citation xml:lang="en">Weeber HA, Eckert G, Pechhold W, van der Heijde RG. Stiffness gradient in the crystalline lens. Graefes Arch Clin Exp Ophthalmol. 2007 Sep;245(9):1357–1366. doi: 10.1007/s00417­007­0537­1.</mixed-citation></citation-alternatives></ref><ref id="cit20"><label>20</label><citation-alternatives><mixed-citation xml:lang="ru">Heys KR, Cram SL, Truscott RJ. Massive increase in the stiffness of the human lens nucleus with age: the basis for presbyopia? Mol Vis. 2004 Dec 16;10:956–963.</mixed-citation><mixed-citation xml:lang="en">Heys KR, Cram SL, Truscott RJ. Massive increase in the stiffness of the human lens nucleus with age: the basis for presbyopia? Mol Vis. 2004 Dec 16;10:956–963.</mixed-citation></citation-alternatives></ref><ref id="cit21"><label>21</label><citation-alternatives><mixed-citation xml:lang="ru">Strenk SA, Strenk LM, Koretz JF. The mechanism of presbyopia. Prog Retin Eye Res. 2005 May;24(3):379–393. doi: 10.1016/j.preteyeres.2004.11.001. Epub 2004 Dec 19.</mixed-citation><mixed-citation xml:lang="en">Strenk SA, Strenk LM, Koretz JF. The mechanism of presbyopia. Prog Retin Eye Res. 2005 May;24(3):379–393. doi: 10.1016/j.preteyeres.2004.11.001. Epub 2004 Dec 19.</mixed-citation></citation-alternatives></ref><ref id="cit22"><label>22</label><citation-alternatives><mixed-citation xml:lang="ru">Anderson HA, Stuebing KK. Subjective versus objective accommodative amplitude: preschool to presbyopia. Optom Vis Sci. 2014 Nov;91(11):1290–1301. doi: 10.1097/OPX.0000000000000402.</mixed-citation><mixed-citation xml:lang="en">Anderson HA, Stuebing KK. Subjective versus objective accommodative amplitude: preschool to presbyopia. Optom Vis Sci. 2014 Nov;91(11):1290–1301. doi: 10.1097/OPX.0000000000000402.</mixed-citation></citation-alternatives></ref><ref id="cit23"><label>23</label><citation-alternatives><mixed-citation xml:lang="ru">Duane A. Studies in Monocular and Binocular Accommodation, with Their Clini­ cal Application. Trans Am Ophthalmol Soc. 1922;20:132–157.</mixed-citation><mixed-citation xml:lang="en">Duane A. Studies in Monocular and Binocular Accommodation, with Their Clini­ cal Application. Trans Am Ophthalmol Soc. 1922;20:132–157.</mixed-citation></citation-alternatives></ref><ref id="cit24"><label>24</label><citation-alternatives><mixed-citation xml:lang="ru">Tsuneyoshi Y, Higuchi A, Negishi K, Tsubota K. Suppression of presbyopia progression with pirenoxine eye drops: experiments on rats and non­blinded, randomized clinical trial of efficacy. Sci Rep. 2017 Jul 28;7(1):6819. doi: 10.1038/s41598­017­07208­6.</mixed-citation><mixed-citation xml:lang="en">Tsuneyoshi Y, Higuchi A, Negishi K, Tsubota K. Suppression of presbyopia progression with pirenoxine eye drops: experiments on rats and non­blinded, randomized clinical trial of efficacy. Sci Rep. 2017 Jul 28;7(1):6819. doi: 10.1038/s41598­017­07208­6.</mixed-citation></citation-alternatives></ref><ref id="cit25"><label>25</label><citation-alternatives><mixed-citation xml:lang="ru">Grewal DS, Brar GS, Grewal SP. Correlation of nuclear cataract lens density us­ ing Scheimpflug images with Lens Opacities Classification System III and vis­ ual function. Ophthalmology. 2009 Aug;116(8):1436–1443. doi: 10.1016/j.oph­tha.2009.03.002.</mixed-citation><mixed-citation xml:lang="en">Grewal DS, Brar GS, Grewal SP. Correlation of nuclear cataract lens density us­ ing Scheimpflug images with Lens Opacities Classification System III and vis­ ual function. Ophthalmology. 2009 Aug;116(8):1436–1443. doi: 10.1016/j.oph­tha.2009.03.002.</mixed-citation></citation-alternatives></ref><ref id="cit26"><label>26</label><citation-alternatives><mixed-citation xml:lang="ru">Teramoto W, Tao K, Sekiyama K, Mori S. Reading performance in middle­aged adults with declines in accommodation. Atten Percept Psychophys. 2012 Nov;74(8):1722– 1731. doi: 10.3758/s13414­012­0360­6.</mixed-citation><mixed-citation xml:lang="en">Teramoto W, Tao K, Sekiyama K, Mori S. Reading performance in middle­aged adults with declines in accommodation. Atten Percept Psychophys. 2012 Nov;74(8):1722– 1731. doi: 10.3758/s13414­012­0360­6.</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
