AAO 2025 Takeaways: A new biomechanical paradigm for presbyopia

Editor's Note: This content was generated with the assistance of AI.

While much of AAO 2025 centered on therapeutics and imaging, AnnMarie Hipsley, PhD, delivered one of the meeting’s most paradigm-shifting talks by re-framing presbyopia as a biomechanical systems disorder rather than a lens-centric condition. Her work from ACE Vision Group laid the groundwork for a future where presbyopia therapy restores full ocular function, not just reading vision.

Presbyopia Is Not Just About the Lens

Hipsley argued that dynamic range of focus—the functional parameter patients actually lose—depends on:

• accommodation
• pseudo-accommodation
• higher-order aberrations
• ocular sphericity
• and especially, pupil dynamics

The traditional narrative that lens stiffening alone causes presbyopia ignores these interconnected biomechanical contributors.

Her team’s work expands the research scope to include scleral rigidity, zonular microstructure, and iris biomechanics—each of which interacts with lens behavior.

New Imaging Tools Reveal the Real-Time System

Recent advances now allow clinicians to observe this system in motion:

• dynamic OCT
• ultra-fast wavefront aberrometry
• ultrasound vibrography

These tools show how structures move together during accommodation, revealing patterns impossible to detect with static imaging.

AI Simulations and the Virtual Eye

One of the most futuristic components of Hipsley’s work is the Virtual Eye Simulation Analyzer (VESA), an AI-enabled modeling platform. Through physics-based simulations and custom VR eye models, clinicians can visualize the functional impact of biomechanical changes and even run virtual clinical trials.

Animations created by Dan Goldberg make complex zonular and scleral interactions digestible, helping researchers conceptualize therapies aimed at restoring elasticity—not just compensating for its loss.

Toward Restorative Presbyopia Therapy

Hipsley’s goal is ambitious yet grounded in emerging data:
restore youthful ocular biomechanics and full physiological function.

This differs fundamentally from current solutions like multifocal optics or corneal inlays, which provide functional improvement but do not reverse underlying biomechanical decline.

The AAO 2025 Biomechanics Takeaway

Presbyopia research is entering a new era—one where the entire accommodative apparatus is understood as a dynamic, interdependent system. ACE Vision Group’s work suggests future therapies may target the root biomechanical causes of presbyopia, rather than simply addressing its optical symptoms.

In many ways, Hipsley’s presentation represents the beginning of a long-needed shift: from lens-centric thinking to whole-eye biomechanics.