CCMS Medicine Fall 2017 - 8

www.CHESTERCMS.org

Hope Springs Eternal and Now Eternal
Glasses-Free Vision is available!
BY STEVEN SIEPSER, MD

I

n my long career as an eye surgeon, I have seen our patients
go from visually handicapped to being the exalted boomers of
the day. When I began training, removing cataracts to restore
some vision resulted in near blindness, coke bottle glasses or thick,
uncomfortable contacts. These unfortunate patients' lives were
forever changed because their vision was distorted, their balance
affected and a cane was often a standard issued item after surgery.
In a very short decade, this changed with the advent of
phacoemulsification (small incision surgery) (think endoscopic eye
surgery) and the addition of implantable lenses, making cataract
surgery a routine miracle. Advancements brought forth actual
accommodating (good for near and distance) implants and Laser
Assisted Astigmatism correcting surgery. Medicare will not pay
for these procedures. They have been deemed elective, thereby
designating them as an out-of-pocket expense. The Center for
Medicare and Medicaid Services (CMS) substantiates by labeling
"corrective" surgery as a patient option. Those not wanting to
wear glasses must pay for these services without any help from
insurance.
Such ophthalmic advancements spawned a new subspecialty,
"anterior segment surgery." We are known as "refractive surgeons"
and perform lamellar (partial) corneal transplants, Radial
Keratotomy, LASIK, ocular reconstruction, iris repair, small
incision cataract surgery, focusing implants, micro incisional
glaucoma surgery, glaucoma lasers and floater removal. There are
at least 18 different operations in the designation. Add to this
mix, young people who have either had LASIK in the past or have
developed the need for "readers." The lifestyle option of vision
correction is considered the holy grail of ophthalmic surgery. It was
predicted that millions would rush to have any procedure to rid
themselves of their dependence on reading glasses or bifocals to see
at near.
The first procedure touting the ability to correct for reading
was Sunrise's laser keratoplasty. It provided a type of monovision
which was not tolerated by everyone. Although relatively safe
and effective, the outcomes were too variable which lead to laser
keratoplasty being abandoned in the '90s. Another excellent
procedure, Conductive Keratoplasty, was developed, producing a
more "multifocal" or "bifocal"-like vision. It worked using radio
frequency waves to congeal collagen, basically changing the curve
on the front of the eye. The "corneal" (the watch glass-like cover
of the eye) could be adjusted and varied as needed and hundreds
were done. The disadvantage was it was very surgeon dependent,
requiring touch ups. Better procedures were needed and they have
finally arrived.

8 C H E S T E R C O U N T Y M e d i c i n e | FA L L 2 0 1 7

The Kamra procedure is based on pinhole technology. A
pinhole camera acts like a perfect lens. It is in focus at all distances
and gives near perfect vision. You can demonstrate this to yourself
by clenching your thumb around your first finger to make a very
small opening with your palm and your first finger. When you
look through that small opening everything will be in focus. The
Kamra Inlay does two things. It provides a pinhole effect for
distance and near, by using a microscopic inlay with a small central
opening.

The Kamra Inlay can be seen under high magnification with
special lighting. It is invisible to the untrained eye.

The central rays are actually in focus at all distances due to the
"pinhole" effect. This actually puts objects in focus at all distances.
The other technology recently approved by the FDA is the
"Raindrop" by Revision Optics. This inlay is a 30 micron thick 1.8
mm diameter hydrogel disc that is placed in the anterior portion
of the cornea. It is more similar to LASIK in that a slightly thicker
flap is made in the same way and the inlay is centrally placed.
http://www.chestercms.org
CCMS Medicine Fall 2017

Table of Contents for the Digital Edition of CCMS Medicine Fall 2017
