Most Americans regard the loss of their eyesight as the worst medical calamity they could experience, according to a survey released in last month from researchers at the Wilmer Eye Institute of the Johns Hopkins University School of Medicine.
Going blind easily topped the loss of a limb, the onset of Alzheimer’s-like dementia, cancer, heart problems and even the ability to speak or hear as the most catastrophic thing survey participants could imagine.
Maybe that’s why Dr. Stephen Tate at New Visions Eye Center here in Vero Beach is so enthusiastic about two of the newest developments in eye care: The “drop-less” cataract procedure and what’s billed as “the world’s smallest medical implant device” – the iSight stent, used in treating glaucoma.
Both cataract and glaucoma are leading causes of blindness worldwide.
Glaucoma, says Tate, “is incredibly common. Particularly here in Vero Beach [because of the older population]. The number of people that have glaucoma or are at risk for glaucoma is incredible.”
Then Tate adds, “In my practice I see … [many] people who have both conditions. I would say anywhere from 20 to 30 percent of people have both cataract and glaucoma.”
“The thing about cataract,” Tate says, “is that virtually 100 percent of people will develop cataracts. Cataract itself is ubiquitous once people get into their 60s and 70s.”
The National Institutes of Health agrees, saying “more than 22 million Americans already have cataracts … the leading cause of blindness in the world. By age 80, more than half of all people in the United States either will have cataract or will have had cataract surgery,” and glaucoma isn’t far behind.
“Cataracts,” explains Tate, “is just a clouding of the lens inside the eye; right behind the colored part of the eye – the iris – there’s a lens and that lens doesn’t turn over throughout your life like, say, your skin, where old skin dies and new skin cells grow. The lens of the eye isn’t like that. The lens that you’re born with stays there. By the time that you’re 60, 70 or 80 years old, the lens in your eye is 60, 70, 80 years old. It just starts to get hazy and cloudy and typically will get a bit yellowish and brown over time. Eventually it gets cloudy enough that it starts to affect the vision.”
During a cataract surgery, that cloudy, hazy natural lens is replaced with a new, clear artificial one known as an intraocular lens.
The basic procedure was FDA approved in the early 1980s and has evolved considerably since then. Today, most such lenses are made of synthetic materials such as hydrophobic acrylics, hydrophilic acrylics or hydrophobic silicone.
The newest advance in cataract surgery – first performed in Los Angeles in 2015 – and now available in Vero, does away with the need for post-operative eyedrops. (More on this below.)
Glaucoma, meanwhile, is trickier. According to NIH, “glaucoma damages the eye’s optic nerve and is another leading cause of blindness.”
But, according to Tate, “the [biggest] problem with glaucoma is that there are no symptoms, typically, until it’s very, very, very late in the game. Once someone starts to notice that their vision is changing – that they’re having problems – they’re really in trouble. The most important thing with glaucoma is to treat it very, very early and try to prevent it from progressing.”
In many cases, one of the biggest obstacles to halting that progression is “compliance with therapy,” and according to Tate that often means patients being unable or unwilling to use their prescribed eyedrops as directed.
And Tate understands why that’s so common.
“That’s the tough one,” Tate says sympathetically, “because that’s the part where people are using drops that are expensive and maybe they find them irritating to the eyes.” Or, Tate continues, maybe arthritis or dexterity issues or memory problems or any number of other age-related obstacles can make using prescribed eyedrops a difficult, if not borderline-impossible, task.
“Over the years,” Tate continues, “there’s been different things developed to try and help people control their eye pressure better without drops. There’s been a push for safer surgical options that can be done earlier in the process that don’t put the patient at risk of any untoward complications. The iStent is one of the developments that’s come out of that desire to develop safer surgical options that are available earlier in the disease process.”
The ultra-tiny titanium iStent – a nearly invisible 0.0393701 of an inch long – can now be implanted into the drainage canal inside the eye to allow excess fluid to drain out and lower the pressure on the optic nerve.
That’s clearly not a job for a rookie surgeon, but despite Tate’s boyish good looks he’s actually something of an old pro at these procedures.
“I was one of the first physicians implanting the iStent in the state and we’ve been at it for a while now,” Tate says – which is actually something of an understatement.
In fact, Tate has already done about 500 of these procedures. Medicare and most insurers will pick up most of the cost.
Dropping the eyedrops is now also a viable option for many – if not all – of those with cataracts, thanks to the new “dropless cataract surgery.” It can eliminate the need for post-operative eyedrops for most cataract surgery patients because the medications in the drops can now, in Tate’s words, “be infused between the little fibers that hold the lens in place” during the procedure.
So, post-op eyedrops may no longer needed at all for most cataract or glaucoma patients.
Regular eye exams are the best and only way to catch these sight-stealing problems while they’re still treatable.
Tate mentions that a further FDA study is now in progress involving the iStent, and says “if anyone is interested, they should call the office” to see if they qualify.
Dr. Stephen Tate is with New Vision Eye Center at 1055 37th Place in Vero Beach, directly across from the hospital. The phone number is 772-257-8700.
