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Latest breakthroughs in eye surgeries give hope to many

May 23, 2019

Cataracts

Protein that comprise the eye’s light-focusing lens continue to clump with years, slowly making vision clouded, blurry 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 lets physicians alter its power 2 to four weeks following surgery, when the eye has healed 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 in 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 precisely the same lens without resorting to another surgery.

Bad night vision together with sensitivity to glare might point to the beginning of cataracts.

Glaucoma

Liquid moving in the eye maintains healthy pressure levels because the surplus drains through a meshwork of outflow canals. If this meshwork falters and liquid 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 potentially serious side effects.

New hope

Advancement meds: Vyzulta, approved by the Food And Drug Administration in November 2017, belongs to an existing class of drugs called prostaglandin analogs and works 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 procedures (MIGS) is a somewhat new development that, while not always as good as conventional glaucoma surgery, causes less trauma and has fewer side effects. The FDA-approved iStent, a tiny tube that restores the traditional outflow of liquid 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 newly received FDA approval.) The similar CyPass Micro-Stent opens a fluid pathway through a different channel. Both are put in at the moment of cataract surgery, so the added operation risk is even lesser. Loss of peripheral vision is a key sign of glaucoma.

Macular Degeneration

Age-related macular degeneration (AMD) has a inherited element, however weight gain, smoking and not wearing sunglasses tend to be among the lifestyle factors that greatly enhance your danger for the disease. It comes about when the macula — the central component 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” form of the disease, leaky blood vessels and scar tissue can significantly increase vision damage. Taking AREDS2 supplements (a combo of vitamins C and E, zinc, copper, lutein as well as zeaxanthin) might decrease the disease’s advancement. For wet AMD, scheduled injections of medications into the eye could inhibit a protein called vascular endothelial growth factor (VEGF), which advances the growth of abnormal blood vessels. Additionally, there are surgical solutions available. However these procedures can just decrease, not end, the advancement of AMD, which can end up in severe loss of sight.

New hope

Gene therapy: We’re nearing the time when genetic causes of diseases such as AMD can be prevented or remedied with gene editing. “A deactivated virus packed with a corrected gene would penetrate cells and put new code into your DNA just like a cut-and-paste on your computer,” Haller explains. In December 2017, the FDA approved this approach for a disease that leads to loss of sight in children — the first gene treatment for any hereditary disease. Professionals anticipate major advance in the following ten years, perhaps even programming the human body to produce its own ­anti-VEGF medication.

Next-gen stem cells: you have heard of embryonic stem cells — and the controversies about using them. Now there’s a different classification of cells that can be derived from your own body and used to develop a variety of brand new cells and tissues, including particular retinal cells that go bad in macular degeneration. A commercially available treatment might arrive within ten years.

An eye telescope: This may be the first and exclusively FDA-approved operative device for people that have end-stage macular degeneration. One eye’s lens gets exchanged with the compact Implantable Miniature Telescope, which magnifies the field of view and boosts central vision. The device is presently limited to people who haven’t undergone cataract procedures, however a brand new study is investigating whether swapping the telescope for a previously installed intraocular lens might safely assist patients.