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New Treatment Advances for Cataracts and Glaucoma

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When you’re nearly blinded by oncoming headlights or can’t read the menu in a candlelit restaurant, you’ve officially entered the world of “age-­related vision loss.”

For many people, such vision loss starts in their 40s or 50s. By age 65, about one-third of Americans will have vision loss due to common conditions such as presbyopia (trouble focusing close up)…or more serious eye problems such as cataracts or glaucoma. 

Latest development: New advances are rapidly improving treatments for cataracts and glaucoma—especially when the problem is caught early.

Here are the breakthroughs to ­consider—and what to watch out for…*

Cataracts

Cataracts are caused by a clouding of the lens that results in such symptoms as blurry vision, cloudy vision, poor night vision and even double vision. The preferred treatment is cataract surgery—a procedure that’s become increasingly effective in recent years. Latest advances… 

• Extended depth of focus lens. With cataract surgery, a surgeon can remove the cloudy, vision-impairing lens of the eye in a matter of minutes and replace it with a clear corrective lens. But until recently, the replacement lens would only enhance either near or far vision in each eye. 

This meant that doctors might treat one eye for near vision and the other eye for seeing at a distance…or they might use a “multifocal” implant that offered some improvement in both near and far vision. Most people simply choose to correct for far vision and use reading glasses the rest of the time.

The new extended depth of focus (EDOF) lens is an important advance because it can correct distance vision while also improving your ability to see up close. For eye surgeons, it’s one step closer to the holy grail—the ability to completely reverse age-related vision loss without the need for glasses. With EDOF, you might actually see better than you ever did.

Drawbacks: The new lenses are expensive. If your insurance doesn’t pick up the tab, you can expect to pay $1,500 to $2,500 more per eye than you would for traditional replacement lenses. 

Even though the new lenses are better for brightness, contrast and seeing colors—and they do improve vision at in-between distances—you still might need reading glasses in some cases.

Best for: Active middle-aged and older adults who want to avoid wearing glasses.

• RxSight Light Adjustable Lens. The FDA approved an artificial lens in 2017 that can be adjusted repeatedly after cataract surgery—important because slight errors in lens manufacturing (or eye changes that occur during healing) can skew the vision-correcting effects. 

This adjustable lens contains a unique material that shifts in response to UV light. If your vision isn’t optimal after the surgery, your doctor can fine-tune it with three or four laser treatments that modify the curvature of the lens, delivered about three weeks after the procedure.

The lens can provide vision improvements that are comparable to vision-correcting procedures such as LASIK. But for now (despite the FDA’s approval), the lens has not yet become widely adopted and is mainly available for patients who are participating in ongoing studies. 

Best for: Any cataract surgery patient who is looking for precise vision correction that is permanent.

Glaucoma

Glaucoma results from fluid buildup that damages the eye’s optic nerve, potentially causing vision loss and even blindness. Depending on the extent of the disease, treatment has traditionally included medication (such as eyedrops or pills)…laser surgery (to help make sure that fluid drains out of the eye)…or conventional surgery (to create an opening for fluid to leave the eye). Latest advances…

• iStent. Because most types of glaucoma are accompanied by excessive fluid buildup (often leading to high pressure within the eye), one of the main treatments is to surgically install a stent (or a related device called a shunt) to improve drainage and keep eye pressure low.

The iStent is a game-changer. It’s the first FDA-approved device that can be implanted during cataract surgery for patients who have mild-to-­moderate open-angle glaucoma, which accounts for at least 90% of all glaucoma cases. The device, which is about one-third the size of a grain of rice, creates a permanent opening to improve fluid drainage. 

Previous devices worked similarly, but they required the surgeon to open a flap of skin from outside the eye, install the stent, then close things up. The iStent doesn’t require a separate procedure when performed with cataract surgery.

Bonus: Patients who have the stent often can reduce their dependence on pressure-reducing medications, which tend to be less reliable and may cause side effects, including extremely low pressure. It’s a phenomenal development!

Best for: Any glaucoma patient who is undergoing cataract surgery.

• Pressure-reducing eyedrops. More than 95% of adults with glaucoma use eyedrops (at least initially) to reduce glaucoma-causing fluid buildups. 

About half of patients require two or more eye medications—and patients using multiple drugs are less likely to follow dosing instructions. The most commonly used medications are prostaglandin analogs (PGAs), which improve the functioning of the drainage pathway known as the ­uveoscleral outflow.   

What’s new: Latanoprostene bunod ophthalmic solution (Vyzulta), approved by the FDA in 2017. Unlike other PGAs, it increases the outflow of fluid through both the uveoscleral pathway and the trabecular meshwork (an area of tissue near the base of the cornea). In studies, it lowered intraocular pressure more than the older drugs…and the dual action means that some glaucoma patients can use only one eyedrop.

My take: All of the PGAs, including Vyzulta, can cause inflammation and red or puffy eyes. For this reason, I believe that glaucoma patients will often do better with other (nonPGA) eyedrops or laser treatments.

Best for: Vyzulta can be a reasonable choice for advanced glaucoma patients who must use eyedrops but are resistant to other products and are not significantly troubled by mild eye inflammation.

*The treatments included in this article may not be covered by insurance. Check with your insurer for details.

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Source: Robert Abel, Jr., MD, an ophthalmologist at Delaware Ophthalmology Consultants in Wilmington and founder/medical director of Medical Eye Bank of Delaware. Dr. Abel is a former clinical professor of ophthalmology at Thomas Jefferson University in Philadelphia and a recipient of the Senior Achievement Award given by the American Academy of Ophthalmology. He is a board member of Vision to Learn, a nonprofit group that offers eye screenings and eyeglasses to students in low-income communities, and author of The Eye Care Revolution: Prevent and Reverse Common Vision Problems. Date: April 1, 2019 Publication: Bottom Line Health
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