Blind World

The Future of Eye Care.

January 6, 2004.

Special to The Miami Herald.

If you're looking to the future of eye care, doctors say one thing is crystal clear: More and more people are tossing out their clunky, rimmed glasses for longer-lasting contact lenses or surgery that goes beyond 20-20.

''The general thing is get rid of the glasses,'' said Dr. Keith Skolnick, an ophthalmologist at the Fort Lauderdale Eye Institute.

From LASIK surgery and contact lenses that reshape the cornea for sharper vision to lens implants that filter out harmful blue light rays for cataract patients, the options are growing multitudinous. (They can run in the thousands of dollars, however, as most insurance companies don't cover the procedures.)

Nonetheless, baby boomers, many of them with aging, myopic eyes, are creating a huge demand for clearer, hassle-free vision as they enter their senior years.

''You can't reverse the aging process,'' Skolnick said. ``The inability to focus up-close worsens as we age.''

But the newest surgery option may allow some people to cheat Father Time. It's an intraocular lens implant called Crystalens, performed in eye surgeons' offices. Doctors can remove healthy lenses of near- or farsighted-patients and replace them with lenses that mimic normal eyes by focusing on both distances and close-up vision. Regular implants correct only for distances; patients must still wear reading glasses.

''As the eye tries to focus, it squeezes on the attachments to the lens to enable the person to see up close,'' said Dr. William Culbertson, an ophthalmologist at the University of Miami's Bascom Palmer Eye Institute, who performs these procedures.

Previously, lens implants were normally done on older patients with cataracts. The new artificial implants can be used for those 45 and up who have not yet developed cataracts but likely will. But it's not cheap at $3,000 to $4,500 per eye depending on where you go.


Doctors also are using lens implants to filter out harmful blue light with cataract patients.

Rochelle Isaacs, 67, of Tamarac, underwent cataract surgery recently at the Foundation for Advanced Eye Care in Sunrise.

Isaacs was awake and alert (but under local anesthetic drops) during the 20-minute procedure in which Dr. Raananah Katz removed the lens and cataract in her left eye and replaced it with a new yellow-colored lens that filters out blue light. Blue light sources include sunlight and some fluorescent lights.

Katz used clamps to pin back Isaacs' eyelids, made a tiny incision on the side of her eyeball and sucked out the old lens with a kind of wet vac machine.

Katz implanted a new lens that contains an ultraviolet and blue light blocker to protect Isaac's retina. In the past, cataract patients who got clear implants later experienced blurred vision.

''This represents something everybody knew should happen and they finally got it right,'' Katz said.

Isaacs said her vision was cloudy and blurred before the surgery.

''Driving was very annoying because I couldn't see the green light and I couldn't read green signs,'' she said, adding she closed her left eye to see better.

''To me the eyesight is the most important body function,'' said Isaacs, an avid reader who loves crossword puzzles but was frustrated by the effort it took to see them.

Doctors are particularly concerned about preventing glaucoma, the second-leading cause of blindness. Blind spots and loss of vision caused by increased pressure within the eye affects those over 50 and African Americans over 40.


The key is catching it early -- before there's irreversible damage to the optic nerve. It can be detected with an eye pressure test performed every two to three years or a microscope that looks for changes in the optic nerve.

Treatments include prescription eye drops, laser treatment and surgery.

Dr. Philip Rosenfeld, a retina specialist at Bascom Palmer, said he is often sought out by elderly patients who flunk the eye exam at the driver's license bureau. ''They dread the idea of being dependent on their kids and others,'' he said.

His specialty is treating the retina, particularly patients with age-related macular degeneration (AMD) who have good peripheral vision but have difficulty seeing objects straight ahead.

The disease usually affects those over 65 but it can begin sooner. Rosenfeld said the newest treatments are two different drugs injected into the eye every four and six weeks, respectively. The drugs inhibit stimuli that cause blood vessels to grow under the macula and impair vision. Early results are promising, but the treatments are still in clinical trials at Bascom Palmer, Rosenfeld said.

Technology, meanwhile, has helped refine LASIK surgery.


Dr. William Culbertson, a LASIK surgery specialist at Bascom Palmer, is one of 70 doctors in the country using a high-speed laser, instead of a surgical knife to cut a flap into the cornea. A laser then permanently reshapes the cornea, potentially giving patients vision that's better than 20/20.

''When [the flap is] cut with a blade, it's always somewhat more loose,'' Culbertson said. With a laser cut, ``it heals so much more solidly.''

He said the device lessens the chance of the flap becoming dislodged and the patient's vision weakening after LASIK. If the flap is knocked out of place, a second operation is needed to reposition the flap and return the patient's visual sharpness. About 1 in 1,000 patients require second procedures.

The cost using the custom laser: $2,250 per eye.


The biggest explosion in eye care affects those 45 and over who need reading glasses for a condition, called presbyopia, which affects an estimated 140 million people in the United States, said Dr. William Winegar, a contact lens specialist at Bascom Palmer.

Bausch and Lomb and Unilens have developed a soft contact lens that's suitable for those to read newspapers or the fine print in books. The lower half of the lens is made for reading while the upper half for normal or distance vision.

''It's the closest thing to bifocals,'' Winegar said.

And those who still want to wear glasses can be fitted for ''progressive'' bifocal lenses. They are ground with different prescriptions on the top and bottom, but without the annoying cut in the glass found in traditional bifocals.

The near-sighted crowd that squints to see objects at a distance also has more options.

CRT -- corneal refractive therapy -- allows them to put the glasses aside. Instead, they sleep with a special contact lens five or six nights a week.

''It recontours the eye,'' said Winegar. ``As long as the patient sleeps in the evening with it, they will wake up with clear normal vision.''

The lens is made of pure silicone rubber that allows oxygen to permeate the lens while the eyelids are closed and greatly reduces the chances of infection, Winegar said. The lens cost $1,100 to $1,500 and are not covered by insurance. Winegar said he has fitted 19 patients with CRT so far.

``They were near-sighted and didn't want to wear contacts. They just wanted to wake up and see well.''

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