A Bright Future for Eye Care

By Stephen M. Felton, M.D.

Imagine never needing glasses — not reading glasses, not glasses for distance, not glasses for astigmatism. That is the challenge that ophthalmology has set for itself for the next decade. It is already happening as new techniques and instruments are being developed at a rapid pace.

This is what I saw and heard at the April meeting of the American Cataract and Refractive Society in San Diego. The great advances in eye care that I personally have witnessed over the past 30 years have been truly remarkable. I would like to share them with you.

First, let me give you some perspective on eye disorders. There are eye diseases such as glaucoma, cataracts, and macular degeneration. Then there are optics disorders such as nearsightedness, farsightedness, and loss of focusing ability, or presbyopia. The primary goal has always been curing and controlling eye diseases, but more recently a lot of progress has been made in treating optic disorders, with the goal of providing excellent vision with no need for glasses. To understand these advances, you need a simplified explanation of how the eye works.

To focus light into the retina so that you can see sharply, there are two eye structures that bend light rays to a fine focus on the retina. They are the cornea, a clear window-type layer on the surface of the eye, and the lens, a clear lens-like structure inside the eye. The cornea has a fixed focus while the lens can move and change shape to provide fine focusing.

When one or both of these structures is defective and cannot focus light onto the retina, the result is an optics disorder. Either by changing the shape of the cornea or by changing the lens of the eye, fine focus – and resulting clear vision – is achieved. The procedure, popularly called LASIK, changes the shape of the cornea to correct nearsightedness, farsightedness and astigmatism. Operating on the lens can also correct optics problems, since one can replace the natural lenses with sophisticated artificial lenses (implants) that will correct nearsightedness, farsightedness, astigmatism and presbyopia – all this to make you free of eyeglasses. When the natural lens in the eye becomes diseased and clouded (a cataract), replacing it not only restores clear vision but can eliminate the need for glasses. The surgical procedures to accomplish all of the above are sophisticated, and require skilled surgeons. For this reason, cataracts are still the main cause of blindness in the world. A great number of people in underdeveloped countries just do not have the access to skilled ophthalmology.

Two examples of the level of sophistication that have recently become available and generated a great deal of excitement in San Diego are advances in ultrasonic technology to allow more efficient and safer removal of cataracts through a tiny incision, and advances in laser technology (Intralase in the United States) to allow more precise and safer preparation of the cornea flap during LASIK.

The ultrasonic method of removing cataracts, also called Phacoemulsification, has become the modern standard. The newer technology is called “torsional Phaco” and provides an extra element of safety and efficiency.

The Intralase laser in its newest model can be used to prepare LASIK flaps with a greater accuracy and safety as compared to the conventional blade technique. Some studies have show that it provides better vision results.

The study of eye diseases is also experiencing great progress. The treatment of glaucoma and macular degeneration has improved greatly over the past 30 years. These conditions are common especially in older populations groups, but to treat them, one has to diagnose them. Both conditions can occur with few symptoms, so screening and/or regular eye examinations after the age of 40 are recommended.

An estimated 2.2 million Americans have glaucoma and another 2 million have glaucoma and do not know it. Without treatment, glaucoma can cause total blindness. Macular degeneration is also a very common eye disease. It can completely destroy central (reading) vision.

In summary, there have been major advances in the treatment of eye diseases and also in the treatment of optic disorders. If you have glaucoma, it can be stopped, and if you have macular degeneration, it can be stopped or slowed down in the majority of cases. If you are motivated to eliminate your glasses this can also be accomplished in the great majority of cases.

You must of course see your eye doctor first. During a routine examination your eye doctor will be able to tell you if you glaucoma or macular degeneration, and whether you are at risk of developing these diseases.  Your eye doctor will also be able to determine whether you are a candidate for vision correction surgery by doing a few additional tests.