Laser treatment promising for presbyopia

MONTE CARLO, Monaco — A treatment for presbyopia using Er:YAG laser energy is showing promise, according to an investigator speaking here. Laser applications peripheral to the cornea decompress selected zones of the sclera with the aim of restoring scleral elasticity and recovering the biomechanical movements of accommodation, speakers here said.

Results of the treatment were presented at the European Society of Cataract and Refractive Surgeons Winter Refractive Surgery meeting.

“LaserACE Decompression decreases scleral rigidity and tissue restriction in three physiological critical junction areas, from approximately 2 mm behind the limbus to the ora serrata,” said Anne Marie Hipsley, director of research and technology at ACE Vision, the company that makes the Er:YAG laser device.

“By releasing these points, the muscles can slide more freely underneath, and the accommodative function can be restored,” she said. “In addition, a series of other functional subsequent downstream effects are obtained, like improving the uveal flow, improving the nutritional standards of the eye and decreasing the IOP.”

Decompression is obtained by transscleral ablation performed in the four quadrants of the globe, approximately 0.5 mm behind the posterior limbus, using a 600-µm tip, she said.

“The surgeon performs a series of nine puncture spots in each quadrant, in a diamond pattern of approximately 4.5-mm-by-4.5 mm, according to the size of the eye. The ablation goes right down from the conjunctiva to the uvea, popping into the superciliary space,” said John Blaylock, MD, a clinical investigator.

Results at 4 years postoperative are encouraging, he added.

“We are restoring the accommodating response,” Dr. Blaylock said. “Patients maintain stable distance vision and have an average gain of 1.43 D of near vision, with a surprising range of 1 D to 8 D. More than 90% of patients don’t wear spectacles at all after the treatment.”