The Market for Spectacle Freedom

In spite of imperfect presbyopia solutions and a depressed economy, the demand for spectacle-free options among the presbyopic is steadily growing. According to an American research company, Market Scope, the penetration of prebyopia-correcting IOLs increased in the fourth quarter of 2009 to about 7% of all cataract procedures in the U.S., said Giulia Newton, vice president of global marketing. She also mentioned that with about 3.2 million cataract procedures performed yearly, which come to about 224,000 cataract procedures using premium IOLs, this penetration has stayed steadily between 6-7% for about 1 year.  On top of that, BSM Consulting Group has also researched those presbyopic patients who opt for premium IOLs had to pay an additional $800 to $900 for multifocal lenses as these are not covered by Medicare. 

In 2010, Professor Howard Fine, who received the Binkhorst Award from American Society of Cataract & Refractive Surgeons, said that even though there are many surgeons doing presbyopic surgeries but IOLs (ReSTOR, ReZOOM) used for correcting both cataract & presbyopia are not in demand yet as patients do not mind using reading glasses or they just want to undergo cataract surgeries. In order to satisfy these patients, IOL manufacturers will continue to work on producing new multifocal and accommodating lenses in order to develop the best technology for cataract-presbyopic patients.    

The latest IOLs developed in England is Rayner Sulcoflex multifocal IOL, which can be implanted in the patients’ sulcus who are pseudophakic with monofocal IOLs.  Another type is Synchrony Dual Optic Accommodating IOL (AMO), which is the first 3D, single-piece, foldable & accommodating IOL with twi separate optics connected by a spring system, that replicates the natural lens by increasing its power when viewing near objects and reducing it when looking at distant objects, allowing the patients to utilize their natural muscle-driven mechanism to move the IOL and achieve spectacle unaided vision.

Besides that, Dr. Fine also mentioned that corneal inlays look like they have some utility and advantages as these inlays are reversible but yet again, the ability to reverse is an imperfect device.  Nevertheless, research has shown that many people in their mid-forties come to the clinics thinking that they have hyperopia, but actually they have slight presbyopia or early signs of cataract. In these cases surgeons will usually recommend an intraocular procedure instead of a corneal procedure to solve both presbyopia and cataract problems. Up till now, laser is used mainly by younger generation to correct their vision, but yet patients with cataracts are unable to use it to remove cataracts and it is definitely an issue worth looking into for the next generation. 

First time watching a vision correction surgery

Before starting to work in GS Eye Center, my image of vision correction laser surgery is only laser and eye but I have never thought deeply about the actual operation process especially for someone who is not from ophthalmology backgroundJ. My cousins and friends had the surgery already and I have received positive feedbacks from them regarding the surgery. 

After my first step into the surgery room, I had to change my uniform and be careful with what I touched. I have butterfingers and I am not a meticulous person. Our eye center has MEL 80, VISX and IntraLase machines, and all these have to be tested every morning before any surgery begins. The machines aren’t huge but the sound VISX and MEL 80 give out during laser process is loud with light burning smell. Of course as a beginner, I wasn’t expecting anything like that and I was shocked to hear the sound. It’s like…a road construction worker drilling a hole in the ground.

After testing, I moved around watching my co-workers preparing the instruments needed for the surgeries on that day and taking notes of what was used during the surgeries. At 11 am, the first patient stepped into the operation room for LASEK using VISX. After explaining the procedure to the patient, eye drops were given to sterilize and anesthetize the eyes. The patient was then brought into the operation room and after lying on the bed, the nurse covered the face area except the eyes with a waterproof drape. The laser sound was then demonstrated for the patient while the nurse washed the eyes with balanced salt solution.

After washing, surgeon came in and he started by using a speculum to keep the eyes open. Then the surgeon used a scrapper to scrap the top layer of the cornea and the laser procedure started. The whole procedure only lasted for less than a minute per eye and eye was washed with saline. Eye drops were used to soothe the eye and speed up corneal healing process. Finally the operated eye was covered with a contact lens (0.0) to enable the cornea to heal without any possibility of inflammation. The surgeon then removed the speculum and repeated the same process to the other eye.

After the procedure, the patient was brought to the recovery room to rest for about 10 minutes and the surgeon checked on the eyes again and set up a follow-up appointment before the patient left the hospital. It was definitely amazing seeing someone walking in the center with glasses and getting out of the center without glasses. The whole procedure was painless but the eyes will start tearing for the next three days as it was a LASEK procedure and eye drops have to be used for at least 2-4 weeks.

Well I think it is definitely worth it especially if I compare it with buying glasses and contact lenses every year, I will be able to save more money in long term run.