I'm Mark Blecher, Co-Director of Cataract and Primary Eye Care at Wills Eye Hospital in Philadelphia. I just wanted to take a minute and talk a little bit about some of the new changes, new products, and some new thinking on the correction of presbyopia.

Presbyopia, as we often say to ourselves, is the Holy Grail of eye surgery. It's the one thing that almost everyone will deal with in their lifetime. It can be one of the most frustrating things to have happen to you and curing it would be almost a miracle. Our profession’s been working quite aggressively to try and address this, both in patients who are not yet in the cataract surgery population and in cataract surgery patients.

There have been many products and procedures that have come and gone to try and deal with this, most of it suboptimally. We don't have the perfect answer yet, but what's interesting is that I think we're starting to get some real traction on some newer and pending technologies that are becoming available.

At this year's ASCRS meeting, AcuFocus announced the FDA approval of the camera intracorneal inlay, which is a small aperture pinhole inlay that can be placed in the cornea at 200 micron depth through a pocket created by a femto laser. The studies seem quite good on this. It's not yet widely accepted around the world where it's been approved for a while, but more recent changes in the clinical indications and surgical technique may improve the results enough to make this something that we here in the United states are going to adopt more aggressively. Current FDA approvals are a little limited at the moment, but practice of medicine should allow surgeons to be able to figure out how to bring this to a wider range of patients - both phakic and aphakic.

Our patient population that we've done refractive surgery on all these years are very anxious, as they get older and many of them are, to cure their presbyopia. You know, they had 20/20 vision for many years if they had their surgery in their 20s or 30s. Now that they’re in their 40s and 50s, they may still have excellent distance vision, but they’re a little frustrated and are happy to have something done to restore their near vision. So perhaps this will be something we can offer them. There is a hydrogel inlay as well that goes in a pocket, also in the cornea, that changes the curvature of the central cornea to allow for a greater depth of focus. That's not yet approved here in the United States but is getting some good feedback on clinical trials elsewhere.

In the realm of cataract surgery we've had a number intraocular lens implants that have attempted to or purported to cure presbyopia or give patients some degree of better reading vision. Whether it’s the pseudo-accommodative crystal lenses or multifocal lenses, they’ve been available for a little while with some success and are being slowly more widely adopted.

This year we've seen some announcements from some of the big lens manufacturers for a wider range of add powers on the multifocal lenses, which hopefully will give a wider range of reading and intermediate vision for our pseudo-phakic patients and, hopefully, also decrease some of the incidents of glare and halos that these lenses can produce.

One of the big issues with using multi-focal lenses, as everyone knows, is that everything has to be pretty perfect for you to get an optimal result. It’s a great technology, and as I tell patients when I’m talking to them about it, there's always a price. So you don't get something for nothing. The multifocal lenses use a trick of optics to try and give you distance and near, and there's a price to be paid for that. So hopefully these newer lenses with lower add powers will decrease some of the issues that we're having and will lead to wider adoption.

On the horizon, there are an extended range of focus lenses which are not yet available in the United States but have been available in Europe for a little while and are getting some positive reviews as a way to provide not quite full reading but to extend the depth of focus for vision so distance and mild, near and intermediate again with less glare and halos less issues related to an imperfect optical system. So it I'm very excited and encouraged that we seem to be making further headway.

The true Holy Grail of curing presbyopia would be to creating a true accommodative lens, which unfortunately seems to keep receding into the future as much as we keep talking about it. So while that would be the perfect solution, I'm afraid in my career and my lifetime that probably will not come to pass. But I think we're getting better and better results, and I'm happy that we have these available.

I look forward to working with the new technologies and bringing them as they get approved here to Wills so that can we can have our experience with them and bring them to our patients.

Thank you very much for your time and attention and appreciate your support.


View Doctors