The treatment options for people with vision problems have changed dramatically over the past decade. New technologies have improved outcomes, reduced patient discomfort and brought an unprecedented level of choice for patients.
We spoke with Dr Kaweh Schayan-Araghi, a consultant ophthalmologist at Artemis Klinik in Germany, about the progress he has witnessed and what the future may hold.
How have treatment options changed for your patients?
Over last ten years or so, the treatments available have improved for people with myopia (short-sightedness), astigmatism (defect in the eye resulting in distorted images), and cataract (a clouding of the lens).
Looking back, the options for patients with astigmatism were especially few for those with low or moderate astigmatism – interocular lenses were really only used for people with much higher astigmatism and it was quite difficult to get a precise correction.
Limbal relaxation incision was also used to correct astigmatism. This involves cutting into the cornea but, to be frank, the outcome was quite unpredictable and uncomfortable for patients. Most endured itching, rubbing and a feeling that there was something in their eye for three or four weeks.
What is available today?
The most dramatic change has been the evolution from implanting just clear lenses to implanting a refractive lens which actually corrects vision: we are now addressing cataracts and correcting vision in a single surgery. This would previously have required two separate operations. So, in a lot of cases we are not just clearing the cataract, the patient could be rid of glasses or have reduced dependency on glasses for the first time in decades.
What kind of attitudinal shift have you seen in ophthalmology?
In the past, the goal of surgery was to improve ‘best corrected vision’. This implies that patients continue to wear glasses. Today, surgeons want to achieve the ‘best uncorrected vision’ – meaning optimal vision without glasses. This is possible in most cases.
With so many options now available, how do you guide patients to make informed choices?
It depends on the patient’s profile – their age and their vision – and their preferences. With phakic IOLs (synthetic intraocular lenses implanted into the eye), patients often ask for comparisons with laser surgery. Laser surgery is still a very good option for people below around 45 years of age who don’t need reading glasses.
However, there are some clear benefits to phakic IOLs: we can treat a wider range of patients than in the past, it’s fully reversible, and doesn’t cause dry eye.
Are patients happy with these newer treatments?
Some of the newer IOLs have slightly bigger optical zones which mean they can be used in younger patients who may have larger pupils but, again, an experienced surgeon is required. In an established clinic, patients are very happy with these products and they have a very good safety profile – I would implant into my sister’s eye if she were to ask.
How well informed are patients on the options they have?
A couple of years ago, there was a lot of education to be done by doctors. If you told them they were unsuitable for laser but could have something else instead they may be hesitant. Now, with the internet, they come in with a lot of knowledge.
Still, we can do more public relations to raise awareness of the options available. Patient associations and trade associations may have a role to play in educating the public – and ophthalmologists have to be more proactive in explaining the value of new treatment options.