By Dr. Barry Drucker
Some claim that an in-office surgical procedure can also accomplish this. The financial stakes are huge, since virtually every person in this country is a potential candidate sometime in his or her lifetime. Let me set the record straight about what is available and what is disingenuous advertising.
Laser treatments
This outpatient procedure, known as conductive keraplasty, uses thermal burns into the cornea to cause shrinkage of the collagen fibers, resulting in a steepening of the curvature of the cornea. This makes the patient near-sighted and able to read. However, this is at the expense of distance vision and the focusing ability is not improved.
Another problem is the regression of the desired effects as time passes with this modality, requiring retreatments.
Surgical procedures to eliminate presbyopia
A few years ago a procedure was developed to allow the ciliary muscle, which is responsible for focusing the human lens, to have more room, enabling it to contract as it did in youthful years. Four or so small scleral incisions are made, which are filled with silicone inserts or spacers to provide the room for ciliary muscle contraction.
The problem with this procedure is the variable results and regression, which often results in no improvement in focusing. Other problems include infections and extrusion of the implants. Clinical trials have been disappointing and the procedure has fallen into ill repute.
Intraocular lenses that focus for far and near
When done properly, modern cataract surgery is refined, quick and an easy recovery. I have inserted many of these implants that give both distance and near vision. Like so many procedures, there are pros and cons. The vision is usually not as crisp as that of standard implants.
Sometimes visual disturbances can temporarily bother patients. Usually these go away when the second eye is operated on. Newer types of implants have been developed and use a spring-like action when one needs to focus on objects close by.
However, without years of experience I am reluctant to insert these. I would like to see if the implants will still move back and forth to focus after many years. Our population is living to very ripe old ages. Will the prosthetics function as long?
What is recommended
I tell my patients that I can get them in focus for far or near, whatever their preference. Most people are pleased to see sharply for distance and put on reading spectacles for near. A new laser-guided instrument called the IOL Master is used instead of the older, less accurate ultrasound to precisely predict what power implant will give the best vision.
I routinely use an implant made by Tecnis, which improves contrast sensitivity and night vision. This has to do with the “prolate” shape of the optic to simulate the vision of a younger person.
On occasion, we plan to have one eye focus for near and the other for distance. Many people enjoy this freedom from glasses and don’t even realize which eye is dominating when both eyes are opened. I often combine the cataract surgery with small, safe, peripheral corneal incisions (done with a diamond blade at precisely 0.600 millimeters depth) to correct any pre-existing astigmatism that might be present.
This gives crisp, unaided eyesight. If the patient is relatively calm, the surgery is done under topical eye drop anesthesia with no patch needed. If, on the other hand, a patient is somewhat squeamish, a safe local anesthesia using a very short needle that cannot perforate any ocular structures is utilized.
The anesthesiologist puts the patient to sleep for about three minutes. This avoids any discomfort or fear of the tiny needle. The patch then comes off a few hours after leaving the recovery room.
Whatever the circumstances, my advice to patients has been to avoid sensational advertisements that make unrealistic claims. A well-trained, experienced ophthalmologist should always be consulted.
Dr. Barry L. Drucker is a board-certified ophthalmologist practicing in Bayside for more than 20 years. He is a fellow of the American College of Surgery and is a diplomate of the American Academy of Ophthalmology and an assistant clinical instructor at the NYU School of Medicine. He can be reached at 718-224-5500. Dr. Elizabeth Kim is also a board-certified ophthalmologist and teaches at the Mt. Sinai School of Medicine.
