SEEING PROGRESS
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The visibility implant allows a greater range of
focus for eyesight in patients.
The implant's size compared to a penny.
Corneal inlays are available but are essentially a modified version
of monovision and one inlay (the Raindrop) has been taken off the
market for causing corneal haze. The Kamra inlay is still on the
market but, in my experience, most patients feel the improvement
is not life-changing.
Multifocal implant lenses like those used post-cataract removal
are an improvement over the above options but still are not without
their issues. Quality of vision and range of focus are limited with
lenses on the market today. Many patients are happy with their
results but all will get some glare and halo. The crispness of vision
may not be great, and the ability to see at all distances in all lighting
conditions is a difficult hurdle for lens manufacturers to overcome.
There is a new trifocal intraocular lens that has been available in
Europe for a while and is said to provide better quality of vision and
a better range of focus, but as of now we are limited and even this
new lens will require removing the eyes’ natural lens.
The goal is to improve near vision in both eyes together without
reducing depth perception, inducing glare and halo that decreases
quality of vision, and working at all distances in all lighting
conditions with as little risk as possible.
I have been involved in two FDA clinical trials that show promise.
The visibility implant is the culmination of work begun about 30
years ago and is now in the hands of the FDA for approval. About five
to six years ago, I began implanting these and have implanted over
300, both in the US as a part of the FDA trial, and internationally
training European doctors in the process of implantation. The
implant is about 2 by 6mm and is placed in a tunnel created in the
sclera 4mm posterior to the limbus in the four oblique quadrants
of each eye. The implant improves the ability of the ciliary body to
change to shape and position of the natural lens of the eye, allowing
a greater range of focus. The central visual axis is not touched, so
there is no risk of decreased sharpness or quality of vision. Range of
focus is seamless from near to distance, and both eyes work together
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preserving normal depth perception. Nothing is removed from the
eye and they are removable is needed. I presented data on visibility
implants for post refractive surgery patients at the European Society
of Cataract and Refractive Surgery; info to date showed that results
were as good for post-LASIK patients as for patients who had no
prior refractive surgery. The advantage of the implant is that, once
implanted, there is no need for further attention by the patient. It
works all day and all night every day.
I am currently involved in a trial looking at an eye drop that
will allow reading without changing distance vision. The drop is
administered once in the morning and can provide reading vision
without glasses for the majority of the day. The drop is used in
each eye and preserves binocular vision and depth perception. It
allows a normal range of focus, but needs to be used each day. The
advantage is that it is non-surgical and non-invasive and can be
used when needed. Phase three of the trial is underway and FDA
approval will likely be in 2021.
There is hope that in the not too distant future, reading glasses
will no longer be a necessary part of life for those of us over 40.
Dr. Meyer is a practicing ophthalmologist at the Eye Care Institute.