Presbyopia Correction

Serving New Jersey, Monmouth County, & Ocean County

Presbyopia is that age-related vision where reading glasses become necessary, even if you’ve had 20/20 vision all your life. At Susskind & Almallah Eye Associates, we offer treatment for presbyopia which has given thousands of our patients relief from having to use glasses.

The cause of presbyopia is not fully understood, but it’s generally thought that the eye’s lens becomes stiffer as we age. This impairs its ability to focus at all distances. When we glance, for example, from the newspaper to the TV to mountains in the distance, and back to the newspaper, the lens is changing its curvature each time we switch focus. It becomes more convex (more steeply curved) for close vision and flatter for distance vision.

This is known as the eye’s accommodation. Tiny muscles (known as ciliary muscles) control that lens curvature. They contract to flatten the lens for distance vision, and relax to steepen it for near vision.

Refraction of Light Rays

When the lens is accommodating to varying vision distances, it is bending (refracting) light, according to the distance from which it came. So for example, when light enters the eye coming from a distant traffic light, it does not need to be refracted as much as light coming from images on your computer monitor.

To see clearly at any distance, there must be a clear image focused on the eye’s retina. That is the light-sensitive back inside surface, which receives image information and sends it to the brain for interpretation. A presbyopic eye is not focusing light from close-up objects on the retina. Instead it is focusing behind the retina.

• A farsighted (hyperopic) eye is doing the same thing, though for a different reason
• A nearsighted (myopic) eye is focusing light in front of the retina
• An astigmatic eye focuses light in more than one place

Those three conditions – hyperopia, myopia, and astigmatism – are treated by LASIK surgery, which changes the shape of the cornea (the clear front covering of the eye). Presbyopia can be corrected using LASIK with monovision – one eye is corrected for close vision and the other eye left as is for far vision. The brain learns to adapt. Research is ongoing for other ways to correct presbyopia, but for now at least, the preferred method is use of IOLs.

Intraocular Lenses (IOLs)

A very successful way to treat presbyopia is by removing the natural lens and replacing it with an artificial lens. This is a short and simple procedure and has been done for several decades. However, in the past ten years or so, IOLs have improved so that now they can not only give clear close-up vision for people with presbyopia, but they can also mimic, or substitute for, the eye’s ability to accommodate.

When the natural lens is removed, so is that ability to accommodate to varying focal points. The three IOLs approved by the FDA for treatment of presbyopia (and also of cataracts), are either multifocal or accommodative. Both types of technology give back the ability to switch focus effortlessly.

Crystalens™ IOL

This IOL is accommodative. It consists of a flat, single-focus lens with two wings which attach to the ciliary muscles. So with a Crystalens in position, you can see clearly at all distances just as you would normally. We don’t normally notice the eye’s muscles contracting and relaxing to change the curvature of the natural lens. Nor will you notice that with a Crystalens implanted.

The Crystalens curvature does not change however. Instead, it moves forward slightly when the eye muscles relax, and this gives clear close-up vision. It mimics the steepening of curvature that would have happened with the natural lens. For far vision, it moves back slightly, which mimics the flattening that would have happened to the natural lens.

ReSTOR® IOL

This is a multifocal IOL. It is not controlled by the ciliary muscles, but instead has concentric steps in its structure, each of which treats light differently. They work together using sophisticated principles of optics so that you can see well at all distances and regardless of how bright or dim the light is.

ReZoom™ IOL

ReZoom is another multifocal IOL. It has concentric zones using a different technology from ReSTOR. Again, each zone refracts light differently so that you can see clearly at all distances and in all lighting conditions.

The IOL Procedure

This is an outpatient procedure and you can return home the same day if you have someone to drive you. Your eye surgeon would first use an ultrasound probe through a small (about one-eighth of an inch) incision outside the visual field. Ultrasound is energy beyond our hearing range, and it gently breaks up the natural lens.

The small pieces are easily removed through the same incision, using mild suction. Then the IOL is placed in position. The incision will heal by itself with no stitches. We will monitor you for about an hour afterwards, and we recommend that you relax and sleep the rest of the day. However, you will notice the enormous vision improvement right away.

We will arrange a series of follow-up appointments for you, to monitor your vision and eye health. Our New Jersey eye surgeons at Susskind & Almallah Eye Associates have a great deal of expertise and experience in IOL procedures. It is a safe and effective procedure and will give you dramatic vision improvement. If you would like to know more about it, please contact us to arrange for a personal consultation. We look forward to working with you.