Laser-eye surgery for older folk

Laser surgery for age-related sight defects is proving popular, writes John Cradden

IF YOU have to hold this newspaper at arm’s length, or squint your eyes while reading this on a screen, it could be well worth your while reading on.

A revolutionary new type of laser eye surgery has been introduced into Ireland over the past year that promises a lifelong solution to presbyopia, an age-related condition that affects all of us to some extent as we reach our 40s or older.

Put simply, as the natural lens inside the eye ages, it becomes less flexible, or stiffer, resulting in problems with things like reading words or focusing on objects up close.

Laser eye surgery to fix presbyopia is nothing new, and many older people fed up of fumbling with multiple reading glasses or contact lenses have opted for one of the well-established procedures available to help with the condition.

But the downside with these procedures, which use lasers to reshape the corneas to improve vision, is that any correction for reading vision may have to be done again in later years as the eyes continue to age.

The difference with the new procedure, called Kamra, is that it promises to offer a more permanent and much simpler fix for the condition.

It involves placing a tiny disk with a pin hole in the middle over the cornea.

William Power, a consultant ophthalmic surgeon at Blackrock Clinic, says the principle behind the idea is an age-old one but is well understood by professional photographers.

“Say you’re taking a photograph of a couple in front of you but you want the mountains behind them in focus as well, what you do is you narrow down the aperture, and that increases the range of the depth of focus. That’s the simple principle, and the same applies to Kamra.”

The inlay is also only inserted in one eye — the non-dominant eye that is used for reading.

Fergal Brehony (52) from Rathfarnham in Dublin, says that undergoing the Kamra procedure was “the best thing he has ever done”.

“For the majority of my life I had perfect vision. Then, like everybody else, once I hit around 40, I needed glasses.”

When he heard about Kamra earlier this year while at Blackrock Clinic, he needed little convincing.

“Even in terms of glasses, I am done now. There’s been an incredible benefit. I haven’t picked up my glasses since the day I had surgery.”

There was no pain or discomfort and, less than 24 hours afterwards, he was able to drive himself down to west Cork.

As well as offering a permanent fix to presbyopia, Kamra is also less of a compromise compared to other surgery procedures, according to Dr Arthur Cummings, a consultant ophthalmologist at the Wellington Eye Clinic and UPMC Beacon Hospital.

Conventional laser surgery involves trying to achieve something called monovision, he says, which means “making the one eye better for distance and making the other eye better for near. What the brain does is, it marries that information and keeps everything in focus, far and near.”

However, some people with perfect distance vision, but who need help with near vision, may not be able to cope with monovision (which can be demonstrated in the clinic or through contact lenses).

They often find, for instance, that while their near vision improves, their distance vision is affected.

‘That’s when Kamra makes sense,” says Cummings. “So you place the Kamra inlay into the reading eye, it improves the reading eye, but without the same loss of vision you get from monovision.”

Blackrock Clinic, which started doing Kamra about six months ago, has done the procedure on over 20 patients so far, while the Wellington, which has offered it for a year now, has done nearer 40.

“It’s growing month-on-month significantly,” says Power, who reports that most of his patients are in their 50s.

At Blackrock, over half of the patients have opted for Kamra in conjunction with conventional laser surgery.

“For a certain percentage of people, their distance vision, at that age, is also beginning to fade a little bit too, and what we find is that with a bit of Lasik, we can improve their distance vision and, with that, their near vision with Kamra also works better.”

This is what Chris Smith (52) from Sandymount in Dublin opted for.

He was fed up with years of fumbling around with multiple sets of reading glasses, and his distance vision had also deteriorated.

He says the two procedures together made a huge difference. “I can say that it has transformed my life. When you have to wear glasses, it compromises quality of life.”

Although the Kamra has been used in select clinics in the EU for up to five years, the company that has patented it has stepped up its availability over the past year.

There have been no reported problems with Kamra, although Power understands that it has failed to work for about one in 100 patients to date. But he points out that the procedure is completely reversible with no permanent damage, something that is likely to help its popularity among those squeamish about the risks of conventional laser surgery.

“You’re just back to square one,” he says.

The cost of the procedure alone is about €2,000 depending on the clinic, but the cost is reduced to about €1,000 if you have it along with a conventional laser surgery procedure, such as Lasik.

It’s not covered by health insurers, but you can offset it as a medical expense against your income tax at 20pc.

Both Brehony and Smith say it’s money well spent. Smith says that, in the longer term, he is likely to save money because of the number of times he was having to get new, stronger glasses every year.

“Apart from that, the improvement in the quality of life is the main thing.”

This article first appeared in the Irish Independent