Progress in Sight

Given a choice of the five senses you would give up, which would you choose? For most of us, sight is the most precious. Researchers and physicians around the globe-and here in Southwest Florida-are applying new technologies and treatments to help save their patients' vision. Advancements in laser treatments, lens implants and medications are at the forefront of the fight against vision loss.

Laser-Assisted In Situ Keratomileusis (LASIK) surgery is the most common type of laser vision-correction procedure. It is an effective treatment for nearsightedness, farsightedness and astigmatism in adults with otherwise healthy eyes.

Dr. Rick Palmon, board-certified ophthalmologist of Southwest Florida Eye Care, performed the first LASIK surgery in Southwest Florida in 1996. Among the many laser systems in use, he says the newest and most effective is wavefront-guided LASIK, also known as "custom LASIK," and marketed under the brand name CustomVue. This technology provides an advanced method for measuring optical distortions in the eye. As a result, physicians can now customize the LASIK procedure according to each patient's vision needs. It produces a detailed map of each eye, as unique as a fingerprint.

"Wavefront technology was originally developed by astronomers to reduce distortions when looking at distant objects in space," says board-certified ophthalmologist Dr. Michael J. Collins Jr., who has offices in Fort Myers and Bonita Springs. "It was used to help fix the Hubble telescope. It is now used by refractive surgeons to detect and treat optical distortions in a patient's eye."

The CustomVue procedure uses iris registration software, a fully automated method of registering corrections that need to be made. Dr. Jonathan M. Frantz, a board-certified ophthalmologist with offices in Naples, Fort Myers and Cape Coral, says, "It identifies key points in the iris so we can lock our treatment on the proper point of the cornea to obtain more precise treatment."

A New Lens

For patients who cannot be helped with LASIK, a new implantable contact lens was recently approved by the FDA. "This is a very thin lens, which is actually put inside the eye," Dr. Richard F. Beatty, of the Physicians Regional Medical Center (formerly Cleveland Clinic Florida Naples), says. A major new advancement in this area is a lens that has multiple focal lengths built in for distance, intermediate and close-up vision.

"We're having very good results with these lenses," Beatty says. "The cataract surgery multiple-focus lens implant is becoming more and more common."

Recent advances in laser refractive surgeries mean that they can now be used to refine vision after cataract surgery, corneal transplants and other ocular operations. "With refractive surgery, such as LASIK, our goal has always been to have our patients glasses-free and contacts-free after surgery," says Collins. "Now our goal is the same with cataract surgery."

Cataract surgery patients in the past ended up still having to wear reading glasses, Palmon says, but the new presbyopic lens implants allow for both up-close and distance vision. The technique is known as "refractive lens exchange," Palmon says, and replaces the cloudy portion of the lens.

But the new lenses, Frantz cautioned, may not be for everyone. He says 20 percent of patients may need glasses after the surgery.

The Latest Medicines

Older eyes are also susceptible to age-related macular degeneration (AMD), a deterioration of the central part of the retina. It remains the No. 1 cause of irreversible vision loss among the elderly. However, there is good news.

"There's been a lot of progress in the treatment of this disease even in the last 18 months," says Dr. Stephen G. Schwartz, a board-certified ophthalmologist at the Bascom Palmer Eye Institute in Naples.

There have been several major advances over the last two years in the treatment of the "wet" form of AMD, so named because it involves bleeding in the macular, the central part of the retina. "Dry" AMD, which accounts for about 80 percent of the cases, progresses more slowly.

In December 2004, the FDA approved a drug called Macugen, which creates a chemical blockade of leaking blood vessels and "immediately changed how this disease was treated," according to Schwartz. Then came Lucentis, a competitor to Macugen that has shown promising results in clinical trials but awaits FDA approval. Both are injected into the eye.

"The third major step forward happened in the last 18 months," Schwartz says. "Avastin, a cancer drug approved by the FDA to treat cancer intravenously, was found to have some efficacy in treating macular degeneration."

Avastin's effectiveness was discovered by researchers at Bascom Palmer's headquarters at the University of Miami Miller School of Medicine.

"They tried putting the drug in the eye, even though it was never intended to go in the eye, and it was more successful than anybody had expected," Schwartz says. "In the last six months to a year, this treatment has become popular worldwide."