Life Is Great

Neil F. Martin, MD, FACS
American Academy of Ophthalmology

s we age, our vision can be affected by a number of conditions, including cataracts, glaucoma, macular degeneration and diabetes-related eye damage as well as presbyopia (age-related farsightedness) and insufficient tear production (dry eyes). Catching and treating these problems early is the key to preventing long-term vision loss.

NEW EYE TREATMENTS

A number of new drugs and lens technologies are making it much easier to treat a variety of age-related eye ailments. The following treatments have become available just within the last several years...

Restasis eyedrops for dry eyes. The drug cyclosporine A (Restasis), used to prevent rejection in heart and kidney transplants, also relieves tear-deficiency syndrome (dry eyes) when used as eyedrops by decreasing inflammation in the tear glands. The drops are applied twice a day to increase tear production. Some people may experience slight stinging at first. Anyone with an active eye infection (such as conjunctivitis) shouldn't use the drops.

Improved glaucoma treatments. A new eyedrop medication, latanoprost (Xalatan), reduces fluid buildup better than older eyedrops. (Glaucoma eyedrop treatments work by enhancing the eye's natural filtering process.) While very safe, latanoprost can cause occasional redness, tends to make eyelashes grow longer and may turn light-colored irises brown over time.

Other new treatments include selective laser trabeculoplasty (SLT), which uses a cool laser to enhance the eye's natural drainage canal and improve flow out of the eye without invasive surgery. SLT uses less energy than its predecessor, argon laser trabeculoplasty, lowering the risk of damaging surrounding tissue. SLT is so effective and safe that it may even become a first-line treatment for open-angle glaucoma, in place of eyedrops.

Eyeglasses with progressive lenses. Progressive lenses are made by a computer to "morph" from one lens setting in the upper half of the eyeglasses (for far objects) into another in the lower half (for close objects). Progressive lenses have been around awhile, but the newest ones are a vast improvement over what was available just a few years ago. Reason: Advanced computer designs allow a smoother transition from far to near.

Improved Lasik. Lasik surgery uses an "excimer" laser that can be focused very precisely to reshape the cornea to correct nearsightedness or farsightedness.

The newest version, the Allegretto Wave, uses tiny pulses of laser light adjusted by computer to match your eye's specific curvature. It can be used to treat more severe cases of nearsightedness, farsightedness and astigmatism, previously untreatable by laser, and also causes fewer side effects (such as seeing halos around car headlights at night), with less need for corrective follow-up treatments. (To find a doctor who uses the Allegretto Wave, visit www.allegretto-wave.com.)

New replacement lenses for cataract patients. Cataract surgery, in which the cataract-clouded natural lens is removed and replaced with an artificial lens, has long been effective at restoring distance vision. Now, several new types of replacement lenses provide improved near and intermediate vision. Each has its own strengths and weaknesses. Discuss with your doctor which is best for you...

The Crystalens from Eyeonics combines the distance vision of a traditional lens implant with an ability to flex slightly and turn into a lens for near vision when the eye muscles focus on closer objects. It's particularly good at providing clear intermediate vision.

The ReZoom lens from Advanced Medical Optics employs alternating zones of near- and far-distance lenses.

The AcrySof ReSTOR lens from Alcon Laboratories has a series of tiny ridges that diffract light (instead of refracting it, like an ordinary lens), enhancing near and intermediate vision. This lens may be the best of the three for focusing on very close objects.

Note: Cataract surgery is extremely safe, with a success rate of more than 95% and a complication rate of less than 2%. Most complications, such as minor swelling of the cornea or retina, increased pressure in the eye or a droopy eyelid, generally resolve themselves with treatment and time. Rarely, cataract surgery can lead to severe visual loss as the result of surgery-related infection, bleeding in the eye or retinal detachment.

New intraocular contact lenses. For those too nearsighted for Lasik, the FDA recently approved the first intraocular contact lens -- Myopic VISIAN ICL from Staar Surgical. The lens is implanted directly in front of your own lens through a tiny incision. The procedure is safe, and the lens can be surgically removed if necessary. A similar lens for farsightedness and astigmatism is in clinical trials.