Procedure could help over-40s toss reading glasses

Despite recent strides in corrective vision, one problem that continued to elude doctors was fixing the inevitable deterioration of reading vision that comes with aging.

Not anymore.

Doctors at the Jules Stein Eye Institute at the University of California, Los Angeles, are testing a new outpatient procedure that has implications for everyone 40 and older - the elimination of reading glasses forever.

''It is an encouraging development for anyone who has hassled with reading glasses or struggled to read a newspaper,'' said Dr. Brian Boxer Wachler, director of the Jules Stein Institute at UCLA.

In short, he is talking about reversing presbyopia - a degenerative condition hat afflicts every person over the age of 50 and nearly everyone over 45. Presbyopia literally means ''old eyes'' and affects the eye's lens in such a way that a person can't focus up close on small objects, including small print.

The condition, up until now, was treatable only with reading glasses. But now the surgeries being done by Boxer Wachler at UCLA are in the first stage of clinical trials and are pending approval from the Food and Drug Administration - possibly as early as two years from now.

And the early results are encouraging, including a litany of cases abroad where people's reading vision improved dramatically from 20/60 to 20/20.

There are 25 patients across the country undergoing the procedure - including Ralph Vandervort, a 57-year-old Ventura, Calif., man who had the surgery done on his right eye on July 12 at UCLA.

Each person in the study paid $3,000 to participate and the procedure covers only one eye.

Vandervort was the third patient to go through the hour-long procedure at UCLA. But before he got to the operating room, he had to go through a battery of eye tests to make sure he was a suitable candidate.

''For 10 years I've been fighting the same battle,'' he said. ''But this is a real convenience. I could struggle with contacts and glasses, but now I'll be appliance-free.''

The theory behind presbyopia and the surgery is a decidedly simple one involving the size of the eye's lens and the ability of surrounding muscle to contract.

As the eye ages, its lens grows bigger, making the space between the lens and the circular muscle that surrounds the lens, called the ciliary muscle, smaller.

Between the ciliary muscle and the lens are almost invisible strands called zonules that act like the elastic cords on a firefighter's round rescue net. When taut, those zonules are what the ciliary muscle uses to pull on the lens - making it thicker or thinner, depending on what the person is looking at.

But when presbyopia sets in and the lens grows bigger and moves closer to the ciliary muscles, the zonules become loose with slack - making them ineffective when the muscle tries to make the lens thicker, so focusing on close objects is possible.

''This happens from the day we're born until the day we die,'' said Dr. Gene Zdenek, a refractive eye surgeon in Reseda, Calif.

Zdenek, who has done about 1,000 scleral expansion band implants outside of the United States, said the procedure is not only safe, but also completely reversible - unlike the popular LASIK surgery, which involves cutting the cornea.

''If someone wants them out, they can be taken out and their vision will revert back to how it was before the procedure,'' he said.

The reversible nature of the surgery lies in its simplicity.

Four plastic implants, each slightly smaller than a pencil tip, are inserted in the white of the eye around the iris at the 10, 2, 4 and 8 o'clock positions.

The placement is close enough to the ciliary muscle to create a lifting action, making the ciliary muscles contract, which creates tautness in the zonules.

Because the implants are slightly curved to fit the eye and also have grooves that dig into the white of the eye - the sclera -they don't move. They can't be seen or felt, either, because the implants are underneath the clear, thin membrane called the conjunctiva.

During the procedure, the conjunctiva is peeled back, and, when it's done, it is put back over the eye.

Zdenek said an interesting phenomenon is also occurring in patients who have the bands in one eye - the vision in the other eye has improved, too.

''When the brain sends an impulse, it's impossible for it to send to only one eye and not the other,'' he said. ''We have sensors in our muscles that dictate a power relationship, and we believe this mechanism is what may be in place for the other eye. We know it's getting increased.''

Because the FDA has approved the study for only one eye, Vandervort will have to wait and see if his left eye begins to correct itself as well.

But, Zdenek said, the procedure is most effective when both eyes are done. The second stage of the clinical trials is expected to begin sometime next year and a third stage will happen shortly after that - with each stage expanding the patient pool while continuing to track Vandervort and the others who were part of the initial scleral expansion bands procedure.

On the Net:

http://www.uclaser.com

http://www.fda.gov

http://www.presbycorp.com

(Contact David Montero of the Ventura County Star in California at http://www.staronline.com.)