New generation of lenses makes evolutionary leap in eliminating need for glasses

Jun 3 2005

The need for reading glasses or bifocals as we age may begin fading from sight with the latest generation of intraocular lenses.

Doctors at UT Southwestern Medical Center are among the first to receive the ReSTOR lens, a new surgically implanted lens that can allow patients who have trouble seeing at arms length to see near, intermediate and far distances without glasses or contacts.

"It's a huge evolutionary step," said Dr. James McCulley, professor and chairman of ophthalmology. "We all want a glasses-free and contact lens-free society and we are very rapidly moving toward that."

The lens' introduction in May came as Medicare announced revisions to some of its payment guidelines, allowing patients covered for cataract surgery to choose the new lens at an added fee. Previous payment rules did not allow the patient to choose this lens, which curtailed interest since the intraocular lenses are particularly beneficial to that age group.

"Had Medicare not done that, the Medicare population would have been excluded and the most frequent operation done for the Medicare population is cataract surgery," said Dr. McCulley, who directs the Jean H. & John T. Walter Jr. Center for Research in Age-Related Macular Degeneration and the Theodore and Mart Beasley Laboratory for Ocular Surface Research.

Previous generations of implanted lenses corrected for cloudiness caused by cataracts and could improve seeing far distances, but most patients still needed reading glasses to see intermediate distances and close up.

Surgical techniques using the ReSTOR lens can fix far-sightedness and near-sightedness, and improve vision at computer and reading distances as well. Techniques using the ReSTOR lens also can correct presbyopia, a pre-cataract condition in which near vision becomes blurry, with a procedure called refractive lens exchange for those who do not yet have cataracts, but want to be glasses free, said Dr. McCulley.

Aging also causes the eye's natural lens to become more opaque, which scatters light and creates cloudy vision, called cataracts. More than half of Americans 65 and older have cataracts, which can be hastened by diabetes, smoking, poor nutrition and other factors.

Eye surgeons correct the cataract problem by removing the clouded lens and replacing it with an artificial lens called an intraocular lens implant, or IOL. Younger patients with presbyopia - but prior to cataract formation - may have all glasses needs fixed with a multifocal IOL, a procedure typically not covered by insurance.

The ReSTOR lens, made by Fort Worth-based Alcon Inc. and approved by the FDA in March 2005, uses a new strategy for collecting and distributing light and doesn't rely on the ciliary muscle, which looses its effectiveness with age.

In clinical trials for ReSTOR, Alcon reported that 80 percent of patients reported "never" wearing reading glasses or bifocals following bilateral cataract surgery. Clinical results showed 84 percent of patients receiving the ReSTOR lens in both eyes achieved distance visual acuity of 20/25 or better, and near visual acuity of 20/32 or better without glasses. That compared with only 23 percent of the control group. More information can be found at www.alconinc.com.

"As part of our approach to this for patients who want to have this done, our commitment to them is that we will get them as close to glasses and contact free as we can within reason with current technology," said Dr. McCulley.