CHEATERS Beware!
Wish you all a wonderful New Year!
As we start the year 2020, I wish to dedicate my innovations toward the final frontier of eye surgery; Presbyopia (reading glasses = cheaters) not only by honing nearly three decades of surgical innovation in this direction but also by building the world’s first Presbyopia Vision Suite.
Have you ever held an iPhone, iPad or newspaper as far as your hands could reach and were still barely able to read? Have you wished there was more light in a restaurant as you looked at the menu? Congratulations! You are now part of the “Elite” club of people over 40 and have a condition called “presbyopia.”
In this article, we shall understand why we end up needing reading glasses as we ‘mature” into our 40s and share new treatments for the same. So, put on your “cheaters” and read on.
In a young eye (less than about 40 years old), your natural lens is fully transparent and also flexible. The lens muscles can easily change its curvature from steeper to flatter, and give you clear vision at all distances. But during middle age, usually beginning in the early 40s, the lens becomes less able to change its shape, so people experience blurred vision at near points, such as reading, sewing, or working at the computer and smart phones. This is known as presbyopia.
You can understand this mechanism as an age-related loss of “zooming power” (“tele & wide,” like a camera) of your natural lens inside your eye (hence you zoom with your arms – short hands syndrome? ).
Given time, presbyopia happens to everyone. Also, you can have other associated conditions (like cataracts, nearsightedness, farsightedness or astigmatism) and presbyopia at the same time. In fact, you can even have 20/20 vision, but still need reading glasses because of presbyopia.
Having worked with over 20 different techniques and combinations using technological evolutions over time, I can say with confidence that most presbyopia patients could be candidates for uniquely designed surgery to see without glasses or contact lenses.
Since this malady will affect almost everyone as they age, why not raise this surgery event to an “experience?” I do believe such a vision suite is the future of eye surgery and will become the predominant ambience of eye surgery worldwide.
It’s a design concept where patients are comfortable, relaxed and excited rather than apprehensive and in pain. With a no-injection, no-pain approach, they could address their frustrating vision issues and aim for vision freedom for each patient’s best potential and, in many cases, even beyond 20/20.
Various options, including “no-cut,” “no-blade” laser precision techniques can be used for patients just with presbyopia and even those with associated nearsightedness, farsightedness and astigmatism.
In patients who do not have a cataract yet, you can get evaluated for advanced laser techniques to optically manipulate vision, so both eyes blend to see at all distances using spherical aberrations and wave fronts as a higher form of vision correction. Corneal inlays are also being investigated for use in this clientele. For patients who are used to mono-vision with their contact lenses (non-dominant eye is focused for near while dominant eye is focused for distance), they can have this arrangement replicated using highly precise lasers.
Refractive Lens Exchange (RLE): Early Cataracts
Further with age, when your natural lens in the eye becomes a cataract (cloudy), a “no-stitch” -“no-injection” and “no blade” cataract-like procedure with new generation multifocal/progressive lens, implants like ReStor, Symfony or Crystalens (very much like bifocal/multifocal/progressive glasses) and even astigmatism-correcting lens implants (Toric) can permanently clear your cloudy vision (from an early cataract). And, in most cases, they will restore your ability to zoom (read) without glasses.
These lens implants are permanently placed inside your eye and replace the cloudy natural lens (early cataract) to aim for vision at all distances for the rest of your life. Thus, while addressing your early cataracts, not only presbyopia but also correction of your associated nearsightedness/farsightedness and even astigmatism be attempted with the same procedure.
Additionally, combination of advanced laser vision surgery can be staged following early cataract surgery (RLE) to complete the vision goal for your individual eye.
By this token, even patients who have had cataract surgery in the past can avail of advanced laser techniques to help correct their refractive errors (remaining glasses prescriptions) and presbyopia to lead a life free of glasses.
As our world comes closer to our circle of vision with smart phones, iPads, Facebook updates and Tweets, we can choose our options to gain vision freedom in this final frontier of vision corrective surgery.
So “cheaters” beware; for presbyopia today, there is no “escape;” you have my full focus and undivided attention!
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at gulanivision@gulani.com or visit www.gulanivision.com