Latest developments in eye surgeries give hope to many

Cataracts

Protein which constitute the eye’s light-focusing lens continue to clump with age, gradually making vision clouded, fuzzy and sensitive to glare. The Symfony lens is just one of the recent breakthroughs.

New hope

Post-op adjustment: During cataract surgery, your ophthalmologist has to estimate the correction your replacement lens needs, but shifts that occur with healing can throw the correction off, resulting in less than optimal results, says ophthalmologist Nick Mamalis, codirector of the Intermountain Ocular Research Center at the University of Utah. The RxSight Light Adjustable Lens allows physicians alter its power 2 to four weeks following surgery, when the eye has treated and refraction has stabilized.

A correction for old replacement lenses: If you’ve already had cataract surgery, you may one day be able to update your existing lens. A system inside the pipeline by Perfect Lens utilizes a laser to alter the correction on a standard lens already in your eye. If your eyes alter over time, you could keep adjusting the same lens without resorting to another surgery.

Poor night vision together with sensitivity to glare may indicate the beginning of cataracts.

Glaucoma

Fluid circulating inside the eye maintains healthy pressure levels because the excess drains through a meshwork of outflow canals. If this meshwork falters and fluid builds up, pressure in the eye can harm the optic nerve and lead to vision loss. Not every patient reacts to current medications, however, and conventional glaucoma surgeries are serious procedures with rare but possibly serious side effects.

New hope

Breakthrough meds: Vyzulta, approved by the Food And Drug Administration in November 2017, belongs to an existing class of medication called prostaglandin analogs and operates by releasing nitric oxide, providing a dual action to lower pressure in the eye. Rhopressa, recently approved, belongs to a new class of medicines called Rho kinase inhibitors; they target cells in the eye’s drainage meshwork to restore outflow.

Microinvasive glaucoma surgery (MIGS) is a somewhat new development that, although it is not always as effective as conventional glaucoma surgery, causes less trauma and has fewer side effects. The FDA-approved iStent, a tiny tube that sustains the traditional outflow of fluid through the eye’s drainage meshwork, is implanted using an incision so small that doctors view it through a microscope. (An even smaller version, the iStent inject, has recently obtained FDA approval.) The similar CyPass Micro-Stent opens up a fluid pathway through a different channel. Both are installed at the moment of cataract surgery, so the extra surgery risk is even smaller. Loss of peripheral vision is a key sign of glaucoma.

Macular Degeneration

Age-related macular degeneration (AMD) includes a genetic element, but weight gain, cigarette smoking and not wearing sunglasses tend to be among the lifestyle aspects that greatly enhance your risk for the condition. It takes place when the macula — the middle portion of the light-sensing retina at the rear of the eye — becomes damaged, resulting in distortion and vision loss in the center of your field of view. In the “wet” type of the disease, leaky blood vessels and scar tissue can significantly accelerate vision damage. Taking AREDS2 health supplements (a combo of vitamins C and E, zinc, copper, lutein and zeaxanthin) might decrease the disease’s progression. For wet AMD, scheduled injections of medications inside the eye could suppress a protein known as vascular endothelial growth factor (VEGF), which advances the growth of abnormal blood vessels. There are also surgical options available. However these treatments can only decrease, not end, the progression of AMD, which can result in extreme blindness.

New hope

Gene therapy: We’re approaching the day when genetic causes of conditions such as AMD can be prevented or cured with gene editing. “A deactivated virus loaded with a corrected gene would penetrate cells and insert new code into your DNA just like a cut-and-paste on your computer,” Haller explains. Around December 2017, the FDA approved this strategy for a condition that leads to blindness in children — the first gene therapy for any sort of inherited condition. Professionals anticipate great progress in the following decade, perhaps even programming the human body to produce its own ­anti-VEGF medication.

Next-gen stem cells: you have been told about embryonic stem cells — and the controversies about using them. Now there’s a different category of cells that can be derived from ones own body and used to grow a wide array of new cells and tissues, including specific retinal cells which go bad in macular degeneration. A commercially obtainable therapy may arrive within ten years.

An eye telescope: This is the very first and only FDA-approved operative device for individuals who have end-stage macular degeneration. One eye’s lens gets exchanged with the compact Implantable Miniature Telescope, which magnifies the field of view and heightens central vision. The device is currently limited to those who haven’t undergone cataract surgery, but a new study is examining whether swapping the telescope for a previously installed intraocular lens might safely assist patients.