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Exciting Times à la the Lens

It's hard to believe that it's been 10 years since my presentation on lensectomy for hyperopia won a best paper award, and only a few dozen months earlier, colleagues got hit with assorted fruits and vegetables for presenting essentially the same material. But with our new appreciation for the quality-of-vision issues caused by our lens, it's not surprising that clear lens extraction is going mainstream.

LASIK for hyperopia remains adequate, but ultimately underwhelming. A wider range of correction is available through lens surgery. Once the natural lens of incorrect power is removed, the surgeon has plenty of options. He or she can leave the patient emmetropic, myopic, with modified monovision, or implant a multifocal lens. In some practices, PRELEX (presbyopic lens exchange) has become a routine off-label treatment for hyperopia with presbyopia. As experience is gained, it's being used more frequently to treat emmetropic presbyopia. With several new multifocals on the horizon, this procedure is on the upswing.

The Visual Fountain of Youth?

Another new wrinkle in lens surgery is the Tecnis, a modified prolate, negative spherical aberration IOL designed to enhance contrast sensitivity after cataract surgery. Our traditional spherical lens implants tend to give pseudophakes the vision quality of a healthy 60 year old. The Tecnis has the potential to give patients the contrast sensitivity of a 20 year old.

If this potential bears out in clinical practice, we may one day find ourselves replacing lenses in middle-aged 20/20 emmetropes simply to turn back their clocks and enhance their contrast sensitivity. Elective lens enhancement could be the visual fountain of youth. We might even find ourselves in favor with the HMOs again. We could climb on board the health maintenance train, improving vision while practicing preventive medicine. Our patients will see better and won't ever get cataracts!

Preposterous? Five years ago I thought so. Now I don't. Our surgical techniques are better, our replacement lenses are more high-tech, and the incentives to pull lens surgery out of the insurance system are enticing. My middle-aged, contrast sensitivity-deficient, keratotomy-scarred eyes struggle at times to see like they used to, but one thing is crystal clear: The next 5 years will be interesting.