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New Hope for Squinting Boomers

 Experimental surgery helps over 40 crowd read without glasses

By Carole Tanzer Miller, HealthSCOUT Reporter

FRIDAY, March 17 (HealthSCOUT) Look out LASIK, there's a new surgical breakthrough that may soon let bleary eyed baby boomers read the fine print without squinting or groping for their glasses.

The painless, 45 minute implant operation  called surgical reversal of presbyopia, or SRP  will be the focus of a Food and Drug Administration monitored clinical trial beginning this month. If the trial is a success, the surgery could be available to patients in the United States as early as 2004, when the youngest boomers hit 40.

That's the age when presbyopia, which can't be cured through LASIK or laser surgery, begins forcing most people to hold things at arm's length to see them clearly. It's a sign of age and it's inevitable. By age 45, nearly nine out of 10 adults need corrective lenses for reading or closeup tasks such as sewing.

"We joke around in the office that it's almost a Viagra issue, it's about quality of life," says ophthalmologist Dr. Barrie Soloway, who will be the principal investigator in the clinical trial at the New York Eye and Ear Infirmary, one of six hospitals taking part in the first phase of the FDA trial. "For all the hype you hear about LASIK, my feeling is this will be even bigger."

SRP offers a revolutionary alternative to glasses that turns traditional thinking about the vision problem upside down, its supporters say.

Doctors have been taught since the mid1800s that presbyopia was caused by a progressive hardening of the lens as people age. That theory made little sense to Dallas ophthalmologist Dr. Ronald A. Schachar, who had treated many elderly patients whose lenses showed no hardening. He theorizes that presbyopia occurs because the lens, like fingernails or hair, grows throughout a person's life, eventually crowding and hampering the muscles that control it.

"There is some skepticism," says Schachar, who developed SRP. "This (procedure) is the proof."

In the operation, doctors insert four tiny implants into pockets created in the sclera, or white part, of a patient's eye. The implants stretch the sclera over the muscle that pulls on the lens to adjust focus. With more room to work, Schachar says, the muscle exerts a more powerful pull, allowing the eye to focus once again at close range on small objects like words on a page.

The surgery is performed under topical or general anesthesia and will probably cost $5,000 to $6,000. The implants, made of the same material used in cataract surgery, can be removed if problems develop.

Best of all, doctors like Schachar say, the procedure is done on part of the eye rarely associated with surgical complications.

An estimated 600 patients worldwide have had SRP. Soloway has operated on several patients in Mexico, one of 26 countries where the implants are already available.

One of them was Bob Gallagher, a Manhattan real estate agent and part-time actor who had the surgery at a Puerto Vallarta clinic last winter.

"It's nothing short of a miracle," marvels Gallagher, who is in his early 50s. "I will never have to wear reading glasses again for 25 to 30 years."

Before SRP, he couldn't see anything up close without reading glasses, from the lines on his scripts during acting auditions to the tiny print in the classified realestate listings he uses in his everyday work. A day after surgery, Gallagher was astonished to find himself with 20/10 vision, able to read the bottom line on an eye chart at 6 inches without glasses.

Eye drops relieved the only postoperative problem he experienced a temporary reduction in tear flow that made him feel as though he were viewing the world through smudged eyeglasses. In Gallagher's view, it was a minor inconvenience that disappeared within a few months.

"For me to be able to pick up anything I want and be able to read it, I didn't think anything about it," he says.

Doctors don't know why it works

Besides dry eyes, patients also may experience temporary redness, tearing or sensitivity to light after SRP, Soloway says.

Eye specialists hope the FDA trial will answer lingering questions about SRP and Schachar's theory. One prominent ophthalmologist says it's not clear how the implants work to reverse the effects of presbyopia.

Dr. Richard W. Yee, professor of ophthalmology at the University of Texas Health Science Center at Houston, used an early version of the implants in a groundbreaking study in the mid1990s. In that study, nine patients each received implants in one eye. Each patient emerged with improved ability to see at close range  not just in one eye, but in both. Yee still doesn't understand why.

"There's no question that this (procedure) is restoring the ability to see up close for whatever the reason," he says. "We don't know the longterm benefits. Assuming that it continues to be good and stable and safe, it will give older people an opportunity to use their own eyes up close. Whether as good as at age 20, I'm not sure."

The 1,435 patients taking part in the clinical trial will get the implants only in their dominant eye that's the one they favor, for instance, when they peer through a rifle scope. They must be at least 50 years of age and have otherwise healthy eyes with no damage to the sclera.

Most of all, Soloway says, they must be "motivated."

"This is surgery, with knives and sewing and what have you," he says. "It's painless, but it's not done with lasers.

Remember: presbyopia is an unavoidable consequence of aging. A 10 year old can see a small object 2 inches from his eyes, while a 30 year old would have to hold it 6 inches away. By age 45, he would have to hold it 12 to 16 inches away.

If you don't want to be dependent on glasses or contact lenses call Vista Alliance Eye Care Associates, The New York LASIK doctors toll free at 1-888-NYLASIK (1-888-695-2745) for more information on any of our Vision Correction procedures (LASIK, INtacs, ICL or SRP), to schedule a personal evaluation to help you determine the right prodecure for you, or to register for one of our classes or  seminars