Ophthalmologists Seek to Deal with Vision Problems in the Elderly

Refractive Lens Exchange

Please also see our article "Understanding Cataracts

(7/17/17)- One of the eye problems that the writer of this item ran across in connection with my vision was something called “blocked tear duct”. A blocked tear drop causes the excess water in your eye to be unable to drain the water in one’s eye, so that it can’t be drained to the nasal passage, which in turn meant that water would flow out of the eye in the form of a tear that constantly flows.

Correcting this problem was rather simple. My eye surgeon injected a saline solution into the tear duct, which unblocked it, so that the water could now flow into my nasal passage, The procedure was simple and I could immediately proceed to whatever activity I chose to do.

(2/22/05)-Anyone over 50 can expect to be seeing a lot more of his or her ophthalmologist. Most of the common eye conditions and diseases that people will encounter in their lifetimes are associated with aging. These include cataract, glaucoma, macular degeneration and the most prevalent sign of the aging eye presbyopia. It is presbyopia or the inability of the aging eye to focus both near and far that has caused generations of seniors to turn to such aids as bifocals, progressive lenses and reading glasses. As we age, the natural lens in our eye becomes less flexible. This lack of flexibility compromises the eye's ability to switch from one focal point (objects at a distance) to another focal point (objects that are close). The practical effect of this loss of flexibility in the natural lens of the eye is that we lose our ability to read or see close objects without reading glasses or bifocals. While they are helpful, most people find bifocals or reading glasses to be a great inconvenience. There is new hope for better vision for presbyopes, especially for those individuals who are either hyperopic (farsighted) or myopic (nearsighted). A relatively new procedure would appear to offer better vision for many years without the need for eyeglasses.

While people in their 20s and 30s are having their vision improved at laser vision correction centers, individuals above the age of 45, who don't have cataracts, may want to look into an elective procedure known as Refractive Lens Exchange, or RLE. Refractive Lens Exchange is a non-laser corrective procedure where the natural lens of the eye is removed and replaced with an artificial lens, similar to cataract surgery. Currently this procedure is for people with moderate to high degrees of nearsightedness or farsightedness.

An advantage of Refractive Lens Exchange is that the individual does not get cataracts, because the natural lens has been removed. The patient can have good-to-excellent near and far vision following implantation of multifocal lenses without the need for eyeglasses, permanent and maintenance-free vision correction without using a laser, rapid visual recovery, and it preserves the central cornea.

A disadvantage of the multifocal lens is that, due to the basic design of the lens, patients usually see faint circles around lights. But I've found that the vision quality and depth of field far outweighs this minor disadvantage, says Guy E. Knolle, M.D., a Texas ophthalmologist.

Because RLE is an elective procedure, payment is out of the patient's pocket at prices ranging from $4,500 to $6.000. The price is comparable to laser vision correction, and most ophthalmogists agree that a lens-based vision correction is much safer for older patients because it reduces the risk of slow wound-healing, dry eye, and complications that can be caused by the creation of the LASIK flap wrinkles, also called striae. These wrinkles may cause ghosting (double image) and poor quality vision. These wrinkles are more prevalent in longer treatment time procedures.

Intraocular Lenses for Cataracts

Today, thanks to the invention of phacoemulsification by Brooklyn-born Charles Kelman, M, D., in the 1970s, seniors are able to have cataracts removed in an almost painless, 15-minute procedure. Phacoemulsification allows cataracts to quickly dissolve and the fragments suctioned out through what is essentially an adaptation of an ultrasound process. Cataract surgeons are reimbursed $150 for each intraocular lens (IOL) they implant during surgery. An intraocular lens is a prescription lens placed inside the eye during cataract surgery, replacing the eyes natural lens (called a cataract when it becomes clouded).

The IOLs available to cataract surgeons today are exceptionally good; with some, even capable of filtering the blue light that many ophthalmologists believe can lead to macular degeneration. Patients implanted with these Medicare-reimbursed IOLs tend to need eyeglasses for reading.

Lens implant surgery has become so advanced in recent years that its benefits have been extended to healthy eyes. Phakic lenses (implanting an IOL without removing the eye's natural lens) is an option available to young patients who may not be candidates for other refractive surgery options. CLEAR, a procedure available today, gives patients over the age of 40 the option to improve their vision without glasses and avoid cataract surgery later in life.

Medicare does not now reimburse for some of the advanced - and more costly - types of IOLs that can now be used in cataract surgery. Negotiations are underway to have Medicare pay for partial cost of this surgery, with the rest paid for by the Medicare recipient.


We at therubins owe the individual who wrote this article exclusively for the "eye" section of this site our deepest thanks.

updated July 17, 2017
addendum by Harold Rubin and Allan Rubin

To e-mail: hrubin12@nyc.rr.

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