Review of ciliary muscle effort in presbyopia.

Fincham's theory of presbyopia would require maximum ciliary muscle contraction to produce maximum accommodative response at all ages. The Hess-Gullstrand theory, however, would allow a maximum accommodative response with a decreasing ciliary muscle contraction as age increases leaving a reserve ability of ciliary muscle to contract with age. If Fincham's theory is correct, a mild parasympatholytic drug would produce a decrease in the amplitude of accommodation, a mild parasympathomimetic drug would produce an increase in the amplitude of accommodation, and the AC/A ratio would increase with age. The results of this study indicate that all three of these do occur and therefore support the Fincham concept of the cause of presbyopia.