- Presbyopia is a growing concern as the global population grows older.
- There is considerable debate between using IOLs or laser treatment.
- The 6th Oracles of Eye Innovation covered the issue in great detail.
When the ancient Greeks wanted to understand the next step to take in their lives, they would often consult an oracle. At shrines around the country, the most famous at Delphi, our Hellenistic friends would ask a priest or attendant a question. The cleric would “consult the Gods,” which usually meant taking some sort of hallucinogenic substance, and responding cryptically, to which the asker of the question would have to translatet.
Nowadays we don’t have to rely on religious folk chewing on substances (though that does not seem to stop some people). But in ophthalmology, of course, we have no truck with such psychedelic conundrums. Indeed, we have our own oracles to help us peer into the future of the industry:the wise, the far-seeing, the all-knowing… Oracles of Eye Innovation.
The sixth webinar in this series of future scrying events was streamed on April 19 and focused primarily on the debate of preferred presbyopia treatment: intraocular lenses (IOLs) or laser. The first presenter was Dr. George O. Waring IV, the founder and medical director of the Waring Vision Institute in Mount Pleasant, South Carolina. His presentation, Contemporary Vision Correction and the Aging Lens, focused a considerable amount of time on Dysfunctional Lens Syndrome (DSL).
The Advantages of RLE
Dr. Waring reported that DSL is split into three stages; The first is presbyopia and higher-order aberrations (HOA); the second involves advancing presbyopia, HOA scatter and early opacity; and the third and final stage includes visually significant HOA scatter and opacity issues that affect daily activities, like cataract. He argued that this three-stage DSL process is an effective way to characterize the aging lens.
With regard to presbyopia, Dr. Waring said his preferred technique is refractive lens exchange (RLE). This is because RLE addresses presbyopia at the source; improves image quality when lens opacities exist; obviates the need for future cataract surgery; preserves or provides stereopsis; and may be useful when corneal refractive procedures are not indicated. The doctor finished his presentation by quoting eye laser scientist Dr. John Marshall, who was in attendance, by posing the question: “Why should the cornea suffer for the crime of the lens?” Food for thought, indeed.
Taking the opposing view in his presentation entitled, The Merits of Laser for Presbyopia Correction was Dr. John Chang, a specialist in ophthalmology and director of the Refractive Surgery Centre at Hong Kong Sanatorium & Hospital. In particular, he focused on highlighting the role of corneal wavefront treatment as best quality vision and night vision are not always possible after refractive surgery. He reported on his research into the issue, which proves the effectiveness of wavefront treatment.
Myopia: A Growing Global Concern
Dr. Chang performed a study on a group of patients with myopia and/or myopic astigmatism with the outcome goal of +0.25 to +0.5D correction. He said corneal wavefront yielded good and comparable visual outcomes with aberration-free patient profiles. Further, eyes that receive this treatment have a higher percentage of achieving 20/15 BCVA than patients that did not undergo the treatment in his research at 82% versus 74%, respectively.
The last presentation focused on new drug delivery technology and was given by Dr. Philip Alexander, a vitreoretinal surgeon at Cambridge Hospital in England. He is also chief medical officer at London-based VisusNano, a pre-clinical company that is developing a pipeline of drug-eluting IOL implants, mainly focused on cataract patients. During his report, Dr. Alexander stated that 93% of patients fail to apply eye drops properly, creating a growing demand for dropless cataract surgery.
VisusNano is developing an eponymous IOL that offers drug delivery properties designed to improve compliance and outcomes, while providing a better experience for the patient. Dr. Alexander said his company has already encapsulated 4 weeks of dexamethasone, 2 to 4 weeks of non-steroidal anti-inflammatory drugs, and 5 to 7 days of antibiotics. A patent for the IOL has been granted in Europe and is presently allowed in the U.S.
Editor’s Note: The Oracles of Eye Innovation Webinar VI was held on April 19, 2021. Reporting for this story took place during the event.
