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Presbyopia treatment arsenal includes laser techniques, corneal implants
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NEW YORK — Refractive surgeons have a growing array of tools at their disposal to treat presbyopia as the baby boom generation enters the Medicare rolls, a surgeon said here.
 Richard L. Lindstrom |
"Surgical correction of presbyopia is truly the new frontier," Richard L. Lindstrom, MD, said during the keynote address at OSN New York 2010. "We've got 78 million baby boomers, and next year the top end of the baby boomers will be 65. The first baby boomers go into Medicare in January, and the youngest will be 45. So, next year, 100% of baby boomers are presbyopic."
Treatment options include lens-based monovision, monovision LASIK, presbyLASIK, femtosecond laser-assisted intrastromal ablation and corneal inlays.
"Monovision works great," Dr. Lindstrom said. He cited a study by Braun published in Ophthalmology in 2008 showing that of 172 LASIK patients, up to 66% of patients older than 45 years preferred monovision. In addition, 20% of the patients were already being treated with monovision via spectacles or contact lenses.
Monovision LASIK yielded an overall success rate of 86% to 97%. However, distance vision required correction to improve night vision and fine near tasks in some cases.
PresbyLASIK can increase spectacle independence by more than 50% but may require re-treatment in up to 28% of cases, Dr. Lindstrom said.
Femtosecond laser intrastromal ablation procedures such as the IntraCor flapless intrastromal correction method reduce pain and minimize complications. According to clinical trial results presented at the 2008 American Academy of Ophthalmology meeting in Atlanta, no eyes that underwent femtosecond intrastromal ablation lost lines of vision or contrast sensitivity. All eyes had functional near vision of J3 or better, and all eyes were emmetropic or slightly myopic.
Corneal inlays have shown some promise but may entail complications such as night vision problems, loss of contrast sensitivity, anterior stromal necrosis and neovascularization, Dr. Lindstrom said.
Dr. Lindstrom, OSN Chief Medical Editor, is a consultant for Alcon and Abbott Medical Optics and a shareholder with LensSx.