Presbyopia Correction: Surgical Reversal

Several methods exist for surgically addressing presbyopia, the common age-related condition in which the eye loses its ability to focus on close objects. In addition to lens replacement options and methods that produce monovision (the adjustment of one eye for distance vision and the other eye for near vision), there are several other surgical procedures that can help correct presbyopia. These techniques include Surgical Reversal of Presbyopia with Scleral Expansion Bands, Anterior Ciliary Sclerotomy, and Laser Presbyopia Reversal. All three methods involve surgery to the sclera (the white, protective outer covering of the eyeball).

Surgical Reversal of Presbyopia (SRP) with Scleral Expansion Bands

In SRP with scleral expansion bands, the eye surgeon implants four tiny plastic inserts (each about the size of a grain of white rice) directly below the surface of the sclera, expanding the distance between the eye’s crystalline lens and the muscles that focus the lens. The additional distance is believed to increase the tension of the muscle, enabling it to focus the lens more precisely.

Presently, clinical trials are being conducted on SRP with scleral expansion bands. So far the results are mixed; some patients experience vision improvement and some do not. Safety concerns about the procedure include the possibility of infection, degradation of the implants over time, and compromised blood circulation in the eye. It is important to find an experienced LASIK surgeon for this procedure, such as Dr. Bruckner of the Academy of Cataract and Laser Surgery in Augusta, Georgia.

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Anterior Ciliary Sclerotomy (ACS)

ACS is based on the theory that the cause of presbyopia is the continued growth of the eye’s crystalline lens throughout a person’s life, which eventually results in a lens that no longer has enough room to alter its shape to change focus properly. In ACS, the eye surgeon makes multiple incisions (usually eight) in a radial pattern on the patient’s sclera, thus increasing the amount of space around the lens.

Although not specifically FDA approved, ACS does not require the use of any unapproved drugs or devices and therefore can be performed legally in the United States. Few published results exist of its effectiveness; early studies showed minor improvements in presbyopia patients’ vision (an average increase of about one diopter).

Laser Presbyopia Reversal (LAPR)

LAPR also is based on the theory that presbyopia is caused by the continual growth of the eye’s lens throughout life. In this procedure, the surgeon uses a laser for ablation (removal of tissue), making eight excisions in a radial pattern on the sclera. This removal of tissue thins the sclera and increases the amount of space around the lens.

SurgiLight, Inc., the company pioneering the use of ablative lasers for presbyobia correction, is conducting clinical trials of LAPR. One study of 55 patients showed an average improvement of 1.9 diopters; a later study demonstrated similar results (with minimal regression shown at the 18-month follow-up).

To receive more information, please contact the Academy of Cataract and Laser Surgery in Augusta, Georgia.