These old, blurry eyes

These old, blurry eyes

They say 40 is the new 30! But your eyes may give you away. Having been in the eye healthcare industry for over 20 years, I've heard all sorts of stories, both funny and not so funny, from patients hitting 40 and above.

And if you're around 40 and reading this, you've probably gone through the same situation: went shopping and thought you found a great deal for a RM100 (S$43) branded shirt, only to find out it's RM700 when you took it to the cashier.

Perhaps you got all dressed up to take your client for lunch at a posh restaurant, only to whip out a pair of "oldie" reading glasses to read the menu and check the bill at the end of the meal. Despite the smart cut of your yuppie power suit and new trendy shoes, you suddenly feel old because of your not-so-perfect reading vision.

However, this is nothing to fret about. It is a natural progression in life. The majority of people in their 40s begin to experience deteriorating quality of their reading vision. This is known as presbyopia, or in regular lingo, rabun dekat and lou fa.

For many, reading is no longer a pleasure and worse still, modern technology has increased the need to read on-the-go, from handheld objects such as handphones to the latest iPad.

What is presbyopia?

Presbyopia is when our eye's natural lens and muscles become too stiff to focus on near objects, due to age. Distance vision is still clear, but objects up close are blurry.

All these can occur:

  • Smaller text is blurred and difficult to read, especially in low light conditions
  • Strained eyes when reading for long periods of time
  • Headaches and/or fatigue when performing near work such as handwriting and needlework
  • Momentarily blurred vision when transitioning between viewing distances
  • Having to hold reading material at arm's length in order to focus properly

    What's the big deal?

So, if it's just a sign of ageing, what's the big deal?

The World Health Organization Vision 2020 Global Initiative for the Elimination of Avoidable Blindness views presbyopia as a large, unmet need, and acknowledges that presbyopia has not been sufficiently addressed as a public health issue.

If you are reading this with reading glasses or multi-focal glasses, you are one of over a billion people in the world who have presbyopia.

Although a high rate of shortsightedness (myopia) in the Asian region enables many people with presbyopia to have functional near vision, the global prevalence of presbyopia is predicted to increase to 1.4 billion by the year 2020.

What causes presbyopia?

Presbyopia is a result of lessening elasticity in the lens, and the loss of flexibilty and strength in the muscle that controls the shape of the lens. Thus, distance vision is not usually affected, but the eye has difficulty focusing on close objects.

There are some uncommon cases of people developing presbyopia in their 30s. This usually happens to those with high hyperopia, otherwise known as longsightedness.

Advanced technology - from blur to clear

When I had my LASIK procedure for shortsightedness done in my 40s, I knew that it would be a matter of time before my near vision would no longer be as clear as before. The common procedure up to the mid-2000s for presbyopic patients with shortsightedness was to deliberately under-correct one eye for them to see near objects, even at the slight expense of their distance vision.

Fortunately for us, there is now a solution available in Malaysia that can improve your reading vision for a lifetime, without compromising on your distance vision.

This is a recent innovative medical device from the US, the AcuFocus KAMRAO inlay, a corneal inlay that restores natural reading vision for presbyopia sufferers. It is a micro-thin inlay in the shape of a "micro-disc" with an opening in the centre, much like a tiny black Polo mint.

The corneal inlay restores near and intermediate vision while maintaining distance vision via a "pinhole effect" that focuses light entering into the eye and blocks unfocused light from reaching the retina.

Lighter than a grain of salt and precision-embedded in the cornea, the inlay is barely visible to the naked eye, and patients will not feel it at all.

The procedure will not affect the patient's suitability for further vision correction procedures such as cataract surgery, and what's more, does not involve any tissue removal.

For shortsighted patients, LASIK is first performed on both eyes to improve distance vision, and then the corneal inlay is placed in one eye to improve near vision.

Involving just a 15-20 minute procedure, a presbyopic patient's near vision is thus restored:

  1. A flap is created in one (non-dominant) eye with the same laser used in LASIK surgeries.
  2. The corneal inlay is then placed onto the eye's cornea layer and centered directly over the pupil.
  3. The flap is then repositioned and the cornea seals itself naturally.
  4. Post-procedure, the patient rests for a short while before leaving the eye centre.
  5. The patient is provided with medicated eyedrops and natural tears to use at regular intervals.

Safety

Safety profile of corneal inlay

The corneal inlay has been implanted in more than a thousand patients during a worldwide clinical trial, which included many countries such as Europe, Japan, UK, US, Australia, New Zealand, Singapore, and the Philippines (during the last seven years). The AcuFocus KAMRAO corneal inlay obtained the CE Mark in 2005, a mandatory mark which certifies that a product has met the European Union consumer safety, health or environmental requirements.

A study published in the Journal of Refractive Surgery (April 2010) concluded that the corneal inlay has the potential for offering a safe and effective treatment for presbyopia. The study shows that corneal inlay has significant improvement in patients' reading vision.

Available in Singapore since March 2008, the corneal inlay is also now available in Malaysia.

The first batch of Malaysian patients who received their corneal inlay in May this year reported a noticeable difference in their near vision within the same day itself. Within days, the majority of patients were able to read moderate to small-sized print unaided, such as text on their mobile phones.

An associate in the eye healthcare industry, US-based Dr Jim Socks, led a highly active lifestyle, until the time came when his deteriorating near vision meant that he could no longer enjoy sports such as scuba-diving. With the corneal inlay, he says he can now admire the beauty of underwater vistas like he used to.

Quoting Dr Socks: "The advantage is that it assists presbyopia sufferers in regaining their active lifestyles without sacrificing intermediate and distance vision.

"The groundbreaking concept behind it is incredibly simple, and the procedure itself is quite straightforward."

Over the years, I have received so many patient requests for something that can restore their reading vision for a lifetime. If you're one of those who can pull off that sophisticated, bespectacled look, count yourself fortunate. But, if like many of my patients, you find your style and freedom cramped by those reading glasses, the corneal inlay may very well be the solution that you have been waiting for.

Choosing the right eye doctor

Choosing the right eye doctor

Our eyes are the windows to our soul, but many of us do not truly value them until our regular vision is compromised.

As many eye conditions do not show obvious symptoms in the early stages, an ophthalmologist would be the best person to go to as they are likely to have the latest and most advanced technology available to examine your eyes and recommend timely treatment.

When choosing which eye specialist to go to, there are a variety of factors to take into account:

Word of mouth: Have you been recommended any particular centre or eye specialist by family and friends? You might feel more comfortable being attended to by people who have treated someone you know.

Authenticity of information: If you are doing your own research on the internet, please make sure that your sources of information are genuine, professional websites, and that the information is backed up by comprehensive medical research and accreditated by medical bodies.

Safety procedures: When visiting your eye doctor, ask for an explanation of the safety procedures in place, and the standards adhered to when undergoing procedures, such as the cleanliness of the operating environment, sterilisation of equipment, and the hygiene of the surgical kit. Is there a 24-hour emergency line you can call for post-surgery needs?

Commitment to patients: Do find out if your eye doctor offers any commitment programmes towards achieving set service outcomes, for example, no additional charge for enhancement of previous LASIK procedure.

Location: Your pupils will be dilated for comprehensive eye check-ups and surgeries, and driving is not recommended for several hours. Make sure that you have accessible transport to return home after your visit to the eye doctor.

Convenience of payment: Does your eye centre provide you with easy, no-frills, transparent, and convenient methods of payment?

Your gut feeling: Our eyes are the windows to our world. When visiting an eye healthcare centre, your safety and comfort is always first priority. If at any time you feel uncomfortable with the place or the people, consider going to a different eye centre or seeing a different eye specialist.

Dr Aloysius Joseph Low is a refractive and cataract surgeon with over 20 years' experience in the eye healthcare industry. He represents Malaysia at the International Society of Refractive Surgery, and is a member of the American Society of Cataract and Refractive Surgery. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice.

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