Surgery for Presbyopia

Last updated on June 6th, 2017 at 05:45 pm

Are you a candidate for presbyopia surgery? Among the most discouraging vision problems is the loss of reading vision caused by a normal, age-related condition called presbyopia. Presbyopia affects practically everybody a long time after age 40 — even if you’ve had “perfect” 20/20 vision the majority of your life or you’ve had your vision remedied with LASIK or PRK when you were more youthful.

Presbyopia Surgery Options

In the past, the usual remedy for presbyopia was to use reading glasses or multifocal eyeglasses, such as bifocals or progressive lenses.

A number of attempts have actually been made to establish a surgical correction for presbyopia throughout the years. Some, such as conductive keratoplasty (CK), initially showed promise, but haven’t acquired widespread use by refractive surgeons.

The following is a brief summary of the current types of surgery for presbyopia that have received FDA approval for use in the United States, and new treatments still in advancement or authorized only outside the United States

Kamra Corneal Inlay

Established by AcuFocus, the Kamra corneal inlay received FDA approval for use in the United States in April 2015. It also is commercially offered in almost 50 nations worldwide.

The Kamra inlay is developed to lower or remove the need for checking out glasses among individuals in between the ages of 45 and 60 who have excellent range vision without glasses however have problems seeing up close due to presbyopia.

The Kamra inlay is very small and thin — simply 3.8 millimeters (mm) in diameter and 6 microns thick (about half the thickness of cling wrap for storing food). It is opaque, with a small (1.6 mm) opening on the center.

The inlay is surgically implanted in the central cornea, directly in front of the pupil of the eye. The main opening in the Kamra inlay develops a pinhole cam effect, broadening the natural range of vision. This sharpens near vision while keeping clear range vision.

The Kamra inlay typically is implanted in the non-dominant eye. This permits both eyes to be used for distance vision, while the inlay hones near vision in the non-dominant eye.

The procedure to implant the Kamra inlay takes less than 15 minutes and can be performed in the eye surgeon’s office. No stitches are required. Recovery time may vary from person to person, however most people have the ability to resume their normal activities, consisting of returning to work, within 24 to 48 hours after surgery.


Surgery for Presbyopia

Raindrop Near Vision Inlay

The Raindrop Near Vision Inlay (Revision Optics) is a small, transparent corneal inlay that gained FDA approval in June 2016.

The Raindrop inlay is simply 2.0 mm in size and is made from a material similar to those used in soft contact lenses.

The Raindrop Near Vision Inlay typically is implanted in the patient’s non-dominant eye through a laser-cut flap in the cornea. The procedure takes only 10 minutes, according to the company.

A clinical trial of the Raindrop inlay exposed 92 percent of people who underwent the procedure had the ability to read newspaper and publication print without reading glasses.

Presbia Flexivue Microlens

The Presbia Flexivue Microlens is another corneal inlay developed to enhance near vision. Developed by Ireland-based Presbia PLC, this device has actually received a CE Mark enabling it to be commercially available throughout Europe, however it is not yet FDA authorized for use in the United States.

The clear Presbia Flexivue Microlens inlay determines just 3.2 mm in diameter and is readily available in a variety of powers, depending upon the patient’s near vision requirements. The inlay can be gotten rid of and changed with a greater or lower power lens if needed.

A European study of the Presbia Flexivue Microlens exposed that 97 percent of individuals stated both their distance and near vision was either excellent or exceptional after the procedure without reading glasses.

A medical trial required for FDA approval of the Presbia Flexivue Microlens procedure began in 2014 and results are anticipated in 2017 or later.

Monovision LASIK

Another surgery for presbyopia that can decrease the need for reading glasses is monovision LASIK. In this technique, the LASIK cosmetic surgeon fully remedies the range vision of one eye (typically the dominant eye), and deliberately makes the non-dominant eye mildly nearsighted.

Monovision LASIK works in lessening near vision problems brought on by presbyopia due to the fact that a mildly nearsighted eye sees near objects plainly without glasses. So, after monovision LASIK, the dominant eye takes the lead to provide clear range vision and the non-dominant eye is responsible for honing near vision.

Monovision of any kind — whether it’s monovision LASIK or monovision with contact lenses — includes some compromise. Though the two eyes continue to collaborate as a team, range vision typically is not as crystal-clear after monovision as it would be if the non-dominant eye wasn’t nearsighted.

Still, many people who undergo monovision LASIK feel the convenience of having the ability to see acceptably well at all distances without glasses deserves the tradeoff of accepting the minor loss of clarity in range vision that monovision entails.

Also, if additional range vision clarity is desired for particular activities (such as driving at night) after monovision LASIK, special-purpose eyeglasses or contact lenses can be recommended that right the nearsightedness in the non-dominant eye and optimize distance vision.

Monovision Conductive Keratoplasty

Conductive keratoplasty (CK) uses low-level, radio frequency energy to diminish collagen fibers in the periphery of the cornea. This steepens the main cornea, in impact extending a too-short eyeball and offer more up-close focusing power.

CK was FDA-approved in 2002 for the temporary decrease of farsightedness, then got approval in April 2004 for the temporary improvement of near vision in individuals with presbyopia.

In a monovision method called NearVision CK (Refractec), conductive keratoplasty is carried out on one eye only — normally the non-dominant eye — to correct presbyopia in an individual who can see well in the range without glasses or contact lenses, but who requires aid with near vision.

Again, it’s a good idea to try monovision with contact lenses or a trial lens in the doctor’s workplace before undergoing NearVision CK to make sure you’ll adapt to it.

After the three-minute procedure, you’ll likely discover enhancement in your reading vision, however it can take a couple of weeks before you reach the last level of vision correction.

One attractive function of CK is that it is minimally invasive. Some people experience tearing, foreign-body experience and/or vision change, but usually this is just temporary.

Refractive Lens Exchange

Refractive lens exchange (RLE) is the elimination and replacement of the eye’s natural lens with a synthetic intraocular lens (IOL) to enhance vision. The procedure is extremely much like cataract surgery, however in RLE the natural lens being removed has not yet ended up being cloudy with a cataract.

Refractive lens exchange can effectively minimize the requirement for checking out glasses with the use of a multifocal IOL or an accommodating IOL. Both of these types of premium IOLs can restore substantial near vision while offering clear distance vision without glasses.

Another alternative is to have your surgeon offer you a monovision correction with refractive lens exchange.

Multifocal LASIK (PresbyLASIK)

Different zones in a multifocal synthetic lens appropriate vision at near, intermediate and far varies. In an investigational procedure known as multifocal LASIK or presbyLASIK, similar zones are produced on the eye’s clear front surface (cornea) with an excimer laser to fix presbyopia.

PresbyLASIK is an investigational procedure, which is not yet FDA-approved. U.S. clinical trials investigating the effectiveness and safety of the procedure presently are being performed.

Dr. D.Roberts / author of the article
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Ophthalmology: Health of Your Eyes
Comments: 1
  1. Alex Higgins

    Presbyopia is typically treated with varifocal glasses, the leading part of the glasses let you concentrate on distant items and the bottom part of the lens lets you focus close up. Normal laser eye surgery or lens implants (like you get after having a cataract removed) do not appropriate presbyopia. You can get multifocal lens implants, however they have side effects such as bad night vision with halos and starbursts around lights. There is in fact an equivalent laser procedure that engraves a multifocal pattern onto your cornea, however it’s my understanding that cosmetic surgeons do not recommend it, even in America where they’ll do almost anything.

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