A new view: Is refractive lens surgery right for you?

Herald Health CorrespondentAugust 27, 2013 

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The youngest baby boomers are just around 50, a prime time for reading glasses. By this age, nearly everyone loses the ability to focus close-up -- think restaurant menus and price stickers on grocery shelves -- and usually it gets worse over time.

Options for a fix-up are plentiful -- from drugstore reading glasses to bifocals and different types of contacts.

Another choice is more permanent: Surgery to remove the natural lens and replace it with a specialty artificial lens for sight at multiple distances. It is the exact same procedure as cataract surgery except that the patients don't have cataracts.

The specialty lenses have been available as an upgrade option in cataract surgery since the mid-2000s and have become increasingly more sophisticated. An implantable lens that corrects for astigmatisms was released in July.

Replacing natural lenses that no longer see perfectly, but aren't clouded with sight-blocking cataracts is called refractive lens exchange. It's an elective surgery that isn't covered by insurance, so it's paid out of pocket.

The procedure has become more popular over the past three to five years, said William Soscia, a cataract and lens replacement surgeon at the Center for Sight in Sarasota.

Surgeons at the Center for Sight, which has offices in Bradenton and Sarasota counties, now perform 300 to 400 refractive lens exchange surgeries per year, he said.

The demand is probably higher than average when compared to other parts of the country.

"Demographics have a lot to with it because we have an older population here," he said.

Meanwhile, people in their 50s and 60s who have small, beginning cataracts that aren't yet affecting vision are opting for early cataract surgery to take advantage of the specialty lenses.

"It used to be that we waited until the cataract was what was called 'ripe,' but now cataracts can be removed if you're affected in any way," said Cathleen McCabe, an eye surgeon at The Eye Associates in Bradenton.

Being "ripe" meant a cataract was large enough to threaten vision and affected patients were typically in their 80s and 90s, she said. Now it isn't uncommon for cataract patients to be in their 50s and early 60s.

Patients who have refractive lens exchange surgery or early cataract surgery often first seek Lasik surgery, said McCabe. Then they learn Lasik, the popular laser surgery to correct vision, isn't an option.

Lasik surgery won't be effective for anyone with a cataract. It also can't help someone with aging eyes that can't read close-up, said McCabe.

Lasik can correct either near- or far-vision, but not both. There is an option where laser surgery can repair vision so that one eye sees far and the other sees close-up that could eliminate the need for glasses. Doctors have people first try a different prescription for contacts in each eye, but some find they can't get used to them.

The best candidate for refractive lens replacement is someone over 50 who is far-sighted, said Soscia. Being highly near-sighted -- when close-up reading is easy and seeing anything far away is a blur -- is an indication against the surgery, he said.

Near-sightedness raises the risk for retinal tears or retinal detachment after surgery. It's best to wait until surgery is necessary for cataracts, said Soscia.

The degree of eye health and conditions such as diabetic retinopathy also are factors that might preclude the procedure. So could young age and simply wanting to get rid of glasses. For this group, Lasik surgery would be a better option.

"For someone who is young and healthy, would I take out a natural lens? No," said Soscia.

For people who do qualify and receive the surgery, about 10 percent will need follow-up laser treatments for the best results.

"Lasik will do the fine-tuning. It's that last little bit of touch-up to sharpen up vision without glasses," said McCabe.

Forty-four-year-old Tony Panico of Sarasota had refractive lens exchange surgery last year. Panico, a PGA club professional, is co-owner of golf marketing and media company Play Golf Sarasota.

Far-sighted and a typical patient, he first sought laser surgery before learning about the lens exchange procedure. The problem was reading up close.

"Even with my contacts in for distance, I was starting to lose the ability to read a check at a restaurant," said Panico.

Immediately after the surgery, he could see clearly both near and far.

"I couldn't believe I was able to see without contacts," said Panico. There was a bit of a halo-like glare around bright lights -- which sometimes occurs with the artificial specialty lenses -- but that went away fairly soon.

Not everything is perfect. Intermediate distances, such as using a computer, aren't completely sharp and sometimes Panico has to pull a book a little closer.

It's something McCabe tells her patients: If you had terrific vision at age 20, don't expect the surgery will restore that perfect sight.

"I tell patients that it will be more like when you're 38. It's not going to be like when you were 20," said McCabe.

Susan Hemmingway, Herald health correspondent, can be reached at shemmingway@hotmail.com.

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