Time to Toss Those Reading Glasses?

From the WebMD Archives

April 6, 2001 -- After 48-year-old Cheryl Goodman had laser eye surgery two years ago, she was able to see without prescription glasses for the first time since the fifth grade.

But for Goodman and most others undergoing the procedure, successful laser surgery did not free her from corrective lenses. Instead, the Dallas-based airline employee traded in her bifocals for reading glasses.

"I really didn't realize how much I would come to depend on reading glasses after laser surgery," she tells WebMD. "I had a pair at work and two pairs at home -- one upstairs and one downstairs. I knew laser surgery wouldn't take care of the reading problem, but I was desperately hoping that something would come along that would."

Last May, Goodman became one of the first Americans to have a two-hour surgical procedure designed to free her once and for all from reading glasses -- although she had to travel to Mexico to do it. The technique is still in early-stage testing in the U.S., and it will be several years before the FDA decides whether to allow it to be performed routinely here.

If the procedure does win FDA approval, the market for it would be huge. That's because virtually everyone develops the condition known as presbyopia, characterized by a reduction in the eye's focusing power, sometime during their 40s. This leads to the need for reading glasses. There currently is no way to reverse the condition, and most people rely more and more on reading glasses as they age.

The presbyopia corrective surgery was developed by ophthalmologist Ron Schacher, MD, head of Presby Corp of Dallas. It is being performed on an experimental basis at a handful of centers in the U.S., under strict FDA guidelines.

Backers say preliminary results suggest the surgery also may be effective in treating two other eye conditions affecting people as they age: primary open angle glaucoma -- a condition in which the pressure inside the eye is too high, causing damage to the optic nerve, which leads to vision loss; and ocular hypertension, in which the eye pressure may be too high but no damage is being caused. This is sometimes a forerunner to glaucoma.

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The procedure involves placing four tiny spherical plastic devices inside the white of the eye, encircling the colored part, known as the iris. The devices push up or stretch the white of the eye, leaving more room for the muscles underneath to work. Schacher theorizes that the lens of the eye continues to grow, like an onion, throughout life, eventually crowding the muscle so that it can no longer exert adequate force to work properly. The theory bucks the widely held belief that presbyopia is caused by the hardening of the lens with age.

While the surgery appears safe, its effectiveness remains to be proven. Goodman says she is thrilled with her results, calling it, "a dream come true."

Schacher tells WebMD the surgery has successfully reversed presbyopia in three-fourths of the 29 patients who have had it performed in the U.S. under early FDA guidelines.

But other eye surgeons report less success, and at least one says he has stopped doing it entirely due to poor results.

Schacher says presbyopia surgery could soon complement laser eye surgery performed to correct nearsightedness, allowing people to have excellent vision into their 60s and even 70s.

"The bottom line is that if you combine laser surgery with our procedure, people would not need glasses for reading or distance," he says.

Washington state ophthalmologist Richard Harmon, MD, FACS, says the two surgeries may one day be offered as a package, with laser surgery performed first, and then the presbyopia surgery performed several weeks or months later.

Harmon, who is president of Cascade Regional Eye and Surgery Center in Arlington, Wash., had the presbyopia surgery in both eyes and also has traveled to Mexico to perform it on three patients. The results, he says, were mixed. He is very happy with his own surgery but says two of his patients did not have successful results.

Ophthalmologist Hampton Roy, MD, says that he, too, has had the surgery and has performed it successfully on three patients. Both Harmon and Roy now own stock in Presby Corp.

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"I do own stock, but I believe it is important to remain cautious about this and any unproven technological improvement," Roy says. "This may be a step toward independence from glasses and contacts, but you can't just assume that everybody will be able to get rid of their glasses and contacts by having this surgery. This is currently in FDA trials, and it may be several years before we know the results of those trials."

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