Cataracts

Protein which comprise the eye’s light-focusing lens continue to clump with years, slowly making vision clouded, blurry and sensitive to glare. The Symfony lens is just one of the recent advancements.

New hope

Post-op adjustment: During cataract surgery, your ophthalmologist has to estimate the modification your substitution lens needs, but changes that occur with healing can throw the correction off, resulting in less than optimal results, says ophthalmologist Nick Mamalis, codirector of the Intermountain Ocular Research Center at the University of Utah. The RxSight Light Adjustable Lens lets doctors alter its power two to 4 weeks after surgery, when the eye has treated and refraction has stabilized.

A correction for old substitution lenses: If you’ve currently had cataract surgery, you may one day be able to update your existing lens. A method in the pipeline by Perfect Lens uses a laser to alter the modification on a standard lens currently in your eye. If your eyes alter over time, it is possible to keep adjusting precisely the same lens without resorting to another surgery.

Poor night vision together with sensitivity to glare may indicate the start of cataracts.

Glaucoma

Fluid circulating in the eye maintains healthy pressure levels because the surplus drains through a meshwork of outflow canals. When this meshwork falters and liquid builds up, pressure in the eye can damage the optic nerve and lead to vision loss. Not every patient reacts to existing medications, however, and traditional glaucoma surgeries are major procedures with rare but potentially serious side effects.

New hope

Advancement meds: Vyzulta, authorized by the Food And Drug Administration in November 2017, is a property of an existing class of drugs called prostaglandin analogs and operates by releasing nitric oxide, providing a dual action to lower pressure in the eye. Rhopressa, recently approved, belongs to a new class of medicines called Rho kinase inhibitors; they target cells in the eye’s drainage meshwork to restore outflow.

Microinvasive glaucoma procedures (MIGS) is a relatively new development that, while not always as effective as traditional glaucoma surgery, causes less trauma and has fewer side effects. The FDA-approved iStent, a tiny tube that restores the traditional outflow of liquid through the eye’s drainage meshwork, is inserted using an incision so small that doctors view it through a microscope. (An even smaller variant, the iStent inject, has recently received Federal Drug Administration approval.) The similar CyPass Micro-Stent opens up a fluid pathway through a different passage. Both are applied at the time of cataract surgery, so the added operation risk is even lesser. Loss of peripheral vision is a key sign of glaucoma.

Macular Degeneration

Age-related macular degeneration (AMD) has a genetic component, but weight gain, cigarette smoking and not wearing sunglasses are among the lifestyle aspects that greatly enhance your danger for the condition. It comes about when the macula — the middle component of the light-sensing retina at the back of the eye — becomes damaged, resulting in distortion and vision loss in the middle of your field of view. In the “wet” form of the disease, leaking blood vessels and scar tissue can drastically speed vision damage. Taking AREDS2 health supplements (a combination of vitamins C and E, zinc, copper, lutein as well as zeaxanthin) might decrease the disease’s advancement. For wet AMD, regular injections of medications inside the eye can inhibit a protein named vascular endothelial growth factor (VEGF), that stimulates the development of abnormal blood vessels. There are also surgical options available. But these treatments can just decrease, not stop, the advancement of AMD, which can result in severe loss of vision.

New hope

Gene therapy: We’re nearing the time when hereditary causes of conditions such as AMD can be prevented or remedied with gene editing. “A deactivated virus loaded with a corrected gene would penetrate cells and put new code into your DNA just like a cut-and-paste on your computer,” Haller describes. In December 2017, the FDA approved this strategy for a condition that causes loss of vision in children — the first gene therapy for any sort of inherited condition. Experts anticipate major progress in the next decade, perhaps even programming the body to produce its own ­anti-VEGF medication.

Next-gen stem cells: You’ve heard of embryonic stem cells — and the controversies about using them. Now there’s a different classification of cells that can be derived from your own body and used to develop a variety of new cells and tissues, such as specific retinal cells which go bad in macular degeneration. A commercially available therapy might arrive within 10 years.

An eye telescope: This may be the very first and only FDA-approved operative device for individuals that have end-stage macular degeneration. One eye’s lens gets replaced with the tiny Implantable Miniature Telescope, that magnifies the field of view and heightens central vision. The device is currently restricted to people who haven’t undergone cataract procedures, but a new study is examining whether swapping the telescope for a previously installed intraocular lens might safely help sufferers.