Presbyopia Surgery -- Full-Length Doctor's Interview

Ivanhoe Broadcast News Interview with
Robert Marmer, M.D., Ophthalmologist
Marmer Medical Eye Center, Atlanta, Georgia
TOPIC: Presbyopia Surgery

Let's talk about what we mean by the surgical reversal of presbyopia. What does that term refer to?

Dr. Marmer: Every person over the age of 40 naturally becomes compromised in being able to do their close work. It's a natural physiology. Up to now, there's been no ability to actually cure presbyopia. There have been lots of ways to compensate for it, reading glasses, bifocals, what we call "mono vision" where we have one eye focus for far and one eye focus for near, which can be done either with contact lenses or refractive surgery such as LASIK or RK. But nothing truly reverses that process. Being able to use your own natural focusing mechanism is what this procedure does. It reverses the aging change. It's one of the only things I know that you really truly can turn the clock back 25 or 30 years and have the natural ability to focus again for up close.

Is this a mechanical correction?

Dr. Marmer: Right. It's a mechanical problem that we are having as we get older. All the medical textbooks tell us the reason we can't see up close after the age of 40 is because the lens gets too hard, and it loses its elasticity and becomes less flexible. This hardness keeps it from changing shape. But what we've really found is instead of that, the lens just keeps naturally growing throughout life. Just like your hair, your nails, and your skin keeps growing throughout life, because the lens comes from the same embryonic origin as the hair and the skin. It's an ectodermal structure. So because it comes from the same origin it does the same thing. So all throughout life, the lens gets just a little bit bigger in very tiny increments, 20 microns a year. At the age of 38 to 42, in everybody the size of the lens starts to encroach on the space between where the muscle is and the lens is and the little fibers that connect between the two.

In order to work efficiently, do those muscles need to be somewhat taught?

Dr. Marmer: Yes. It's just like your muscle going to the tendon which attaches to the bone. If the tendon is loose or ruptured, you can't move it. So what happens as the lens gets bigger these little fibers between the muscle and the lens gets loose. And the looser the littler fibers get the less ability there is to change the focus and eventually you just lose all ability to focus up close what so ever.

So, the introduction of these bands restores that tension?

Dr. Marmer: Exactly. What happens is we place these little bands right in the wall of the white of the eye. We don't go inside the eye, this is just partially under the surface of the white of the eye -- we place it right above the muscle. So what happens is it pushes that muscle and expands the muscle, puts the little fibers on stretch again. Now you've got the ability for the muscle to transmit the force once more to the lens, and it changes its focus. It's just like tightening the springs on a trampoline and now the trampoline works again. If it's too loose you can't get any bounce to it.

As eye surgery goes, how would you characterize this in terms of its complexity or risk?

Dr. Marmer: Well it's really not very complex and the risk, because you don't go inside the eye, is really pretty minimal. LASIK, RK, everything that's external to the inside of the eye eliminates some of the major fears of eye surgery, you know, infection inside the eye, which is one of the most feared sorts of complications that we can have in ophthalmology. But this is external to the inner portion of the eye, and it's really very safe.

And technically easy for an experienced physician to do?

Dr. Marmer: Right as long as you're a skilled physician. It's not easy but if the physician is trained to do ophthalmic surgery they should be able to do this procedure.

How long typically does it take to do?

Dr. Marmer: It's not as fast as LASIK and RK -- it's not just a few seconds or a few minutes because you're really doing a manual procedure and nothing is touching the cornea, so we're not changing the patient's ability to see or to focus. All we're doing is restoring the mechanics of being able to accommodate this. We call it accommodation when we change from distance to near. And by putting these little bands in, we re-establish the anatomy, the structure of the way things used to be before the little fibers got loose. We make a little tiny parallel set of incisions about three millimeters behind the area where the clear part of the eye meets the white of the eye. And we make this on the white of the eye. Then we connect these two little partial thickness incisions into the white of the eye with a tunnel. And we just slip these little plastic bands, the same exact material that we use for the intraocular lenses that we do cataract surgery with. We've been using this material for 50 years so it's nothing that's experimental. These little bands create this lift of the white of the eye and just put those little fibers back on stretch. As soon as you get off the table you look down and you can read. It's incredible, it really is.

It seems like anything in the white of the eye might be annoying like a speck of sand. What is the sensation?

Dr. Marmer: With this, you don't really feel it because it's essentially your natural white of the eye that the lid is covering because the segment is beneath the surface. So you don't feel it. If you pull your lid down and look into a mirror you could probably see where it was. But someone looking at you could not see it.

After it's healed, people don't notice it?

Dr. Marmer: No. The eye tends to be bloodshot for maybe four to six weeks. But once that goes away no one can tell that you've had anything done.

The field of vision is not involved in this procedure; you're working outside the field of vision, right?

Dr. Marmer: We're working outside the corneal completely. So no difference, you vision is going to be exactly the same for far away as it was before the procedure was done. So let's say you have perfect 20/20 vision for far away, you just can't read. This procedure will be able to re-establish everything. Keep the far like you have and improve the near. If you have nearsightedness, farsightedness or stigmatism, that can be corrected to make the distance vision clear with either LASIK or RK or any of the refractory procedures. Then do this as an additional procedure to be able to read.

The interesting part of this procedure is that this is one of the only eye surgeries that I know that puts a lot of the responsibility of the success on the patient. Because for years these patients may not have been using their ability to focus up close. They've been using a crutch, reading glasses or bifocals. So the muscle that ordinarily would be utilized to focus up close is weak and it hasn't been used for 10 years or 20 years. So once we do this procedure you can look down and read but all of a sudden you know I just feel so tired. Because it's like trying to run the marathon and you never trained. So you have to re-establish the muscle tone to be able to use a prolonged ability to read up close for a long period of time.

END OF INTERVIEW

This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.

If you would like more information, please contact:

Robert Marmer, M.D.
Marmer Medical Eye Center
777 Cleveland Ave. Suite 102
Atlanta, GA 30315
Marmer2020@aol.com
http://www.marmer2020.com