Squinting while texting? Always losing your reading glasses? An eye implant that takes about 10 minutes to put in place is the newest procedure to correct the blurry, close-up vision that comes with middle age.
“It’s not bringing anybody back to being 20 again,” cautioned Dr. Shilpa Rose, a Washington ophthalmologist who tests whether patients’ eyes are healthy enough to qualify for the surgery. “But it decreases the need to rush to get that pair of reading glasses every time you want to send a text or read an email.”
Most people begin to experience presbyopia — difficulty focusing on nearby objects — in middle age, typically in the mid-40s. At first, you may find yourself holding books, your phone and restaurant menus at arm’s length. Eventually, even in good light, reading becomes a blur.
How well you see has to do with how light passes through your eye — specifically the lens and cornea, a dome-shaped structure at the front of the eye. As you age, your eye’s lens stiffens and becomes less flexible, losing its ability to focus on close-up objects.
Buying a pair of drug store magnifying glasses for reading can help, but some people with other vision problems choose bifocals, multifocal contact lenses or monovision lenses, which correct for distance vision in one eye and near vision in the other.
“I have glasses everywhere — the bedroom, the office, the kitchen,” said Christianne Krupinsky, 51, of Marriottsville, Maryland, who never needed them until presbyopia struck. “Getting ready in the morning, even to put on jewelry I can’t see the clasp. It’s so frustrating.”
The new surgery involves implanting corneal inlays into the eye’s clear front surface, which are removable if necessary. Still, surgery carries some risks and follow-up is key.
“It’s not magic. It’s surgery. People have to remember this is not one and done,” but requires post-surgical exams and care, said Dr. Deepinder K. Dhaliwal of the University of Pittsburgh Medical Center, a corneal specialist who is watching studies of the inlays.
Krupinsky was a little nervous while lying on the operating table to receive the new Raindrop Near Vision Inlay.
“The most you’re going to feel is pressure,” promised Washington refractive surgeon Dr. Mark Whitten, who applied numbing drops to Krupinsky’s left eye.
A gel-like device that looks like a miniature contact lens, the Raindrop inlay is smaller than the eye of a needle, and is placed in only one eye. It is the first implant to treat presbyopia by changing the cornea’s shape, making it steeper, to alter how light passes through it.
Patients can test-wear a single contact lens to be sure they’ll like the effect before choosing surgery.
Ophthalmologist Rose checked for dry eye, underlying diseases like glaucoma, and whether the corneas were thick and healthy enough to receive the implant before turning Krupinsky over to her surgical partner.
“Just look straight up,” Whitten said as he used a laser to slice a flap in Krupinsky’s cornea during her surgery. He centered the Raindrop inlay over her pupil and lowered the flap to seal it in place.
Minutes later, Krupinsky read lines on an eye chart she previously couldn’t make out without glasses, although she said it still appeared a little blurry. She’ll need eye drops for several months as her cornea heals.
The device maker, ReVision Optics Inc., a company based in Singapore, is gradually training eye surgeons to use the inlay properly. The Food and Drug Administration approved it last summer based on a study of 373 people whose only vision problem was moderate presbyopia. Two years later, 92 percent had good near vision — 20/40 or better without glasses — in the implanted eye.
Potential side effects include infection, dry eye, glare and corneal problems, including scarring. About 7 percent of study participants had the implant removed, mostly because they weren’t satisfied with their vision or experienced a haze or clouding of the cornea. Most returned to their pre-surgical vision, although one had lingering haze.
Other surgical options:
- Another FDA-approved corneal inlay, the Kamra, is a doughnut-shaped device, also used in one eye and removable. It works like a pinhole camera, improving vision by focusing light through the center of the pupil.
- A more invasive operation replaces the natural lens in each eye with an artificial one, called Symfony, that can focus both near and far. Approved for cataract surgery, it is also being offered as a presbyopia fix for middle-age people who don’t yet have cataracts. Unlike inlays, artificial lenses can’t simply be removed.
One glitch: insurance doesn’t cover elective presbyopia surgery. Rose said the inlays average about $4,000 to $5,000, while the artificial lens in both eyes can cost twice as much.
Patients should consult an experienced eye surgeon knowledgeable about all of the options and who can help determine which best suits best suits their eyes, advised Pittsburgh’s Dhaliwal.
Each option has pros, cons and unknowns. For example, elective lens replacement isn’t for the very nearsighted because those patients are at a higher risk for a vision-threatening complication, Dhaliwal said.
Another caveat: the Raindrop inlay procedure hasn’t been studied in people who have undergone laser eye surgery (LASIK, for example) surgery to correct nearsightedness. That didn’t deter Mike Gray, 52, of Haymarket, Virginia, though, who lost his reading glasses so often that he bought bulk packs. To implant the inlay, Whitten had to avoid cutting the cornea in the same place as Gray’s long-ago LASIK, and advises such patients to pick a surgeon experienced in both procedures.
“Everything is very clear and getting better every day,” Gray said about a month after his surgery.