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To Squint or to See the Light

January 6, 2009


There was an excellent article in last week’s health section of the New York Times titled To Squint or to See the Light. This article discussed several surgical options available to treat presbyopia. Presbyopia is an age-related change in vision that occurs when the eye’s lens begins to harden, becoming less flexible, and preventing the individual from focusing properly on nearby objects. I have already discussed presbyopia in previousblog posts.


The article discussed an investigational treatment, Transsclerallight Therapy, which is undergoing FDA clinical trials. This procedure involves using a laser light to treat the ciliary muscle in an attempt to strengthen the eye’s lost ability to focus. The treatment protocol involves many visits and re-treatments. It is yet to be seen whether this treatment will be effective and long-lasting.

According to the article:

“Of the study, Mr. Savin said, “At first, I was skeptical.”

But after undergoing weekly 10-minute sessions at an ophthalmologist’s office for five consecutive weeks, followed by periodic tune-up sessions about every six months, Mr. Savin said he has not needed reading glasses and only occasionally uses his distance glasses for driving at night.

With the last of the baby boomers turning 45 this year, experts in the eye care industry say the potential for the presbyopia correction market is huge.

In addition to transscleral light therapy, there are several surgical options available today, including refractive lens exchange. This outpatient surgery, which is typically performed on cataract patients in an ophthalmologist’s office, involves replacing the natural crystalline lens with an artificial one, of which three have recently been approved by the F.D.A. to correct for presbyopia.

But even though refractive lens exchange is only covered by insurance if a patient has cataracts, last year about 38,000 Americans chose to have their natural lenses replaced with lenses that correct for vision problems, including presbyopia, Mr. Harmon said.”

The article gives a complete list of all treatment modalities available for the treatment of presbyopia:

Progressive Addition Lenses. The lenses offer a more gradual visual transition between the two prescriptions, with no visible lines between them. Usually worn all day.

Bifocal and Multifocal Contact Lenses. These carry a prescription for nearsightedness or farsightedness, with a stronger prescription for close work. The brain makes the correct choice depending on how close or far you are trying to see.

Monovision Contact Lenses. One eye wears a lens with a distance prescription, the other wears a lens for near vision. The brain learns to favor one eye or the other for different tasks.

Conductive Keratoplasty (CK). This three-minute outpatient surgical procedure uses low-level radio-frequency energy to shrink collagen in the periphery of the cornea. This steepens the central cornea, in effect lengthening a too-short eyeball. The procedure is used to help one eye see better up close, while the other eye is untouched.

Monovision LASIK Surgery. One eye is corrected for distance vision and one for near vision. It is a 10- to 15-minute procedure per eye, and is usually done in one visit. As presbyopia progresses, additional surgeries may be required.

Refractive Lens Exchange or Clear Lens Extraction. This 15-minute outpatient procedure is usually done one eye at a time with a couple of weeks between surgeries. It involves removing the eye’s natural lens and inserting an artificial one in a procedure identical to cataract surgery.

TAKE HOME MESSAGE: With the aging baby boomer population, presbyopia is becoming more and more common. Boomer’s do not like to wear readers. There are several options available, both surgical and non-surgical, that can address presbyopia.I find the results of refractive lens exchange with the implantation of a multifocal IOL offers exceptional results to my patients.

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