Forty may be the new 30 but there is no telling the ageing process that, judging by the many people who end up donning fuddy-duddy reading glasses once they hit middle age. They are blindsided by a common ailment that affects people once they get older – presbyopia or “lao hua yen”, which literally means old people’s eyes in Chinese, but doctors say the condition afflicts younger people too. This is the gradual loss of ability to focus on near objects as one ages due to the weakening of the muscles supporting the eye’s lens.

Professor Donald Tan, medical director of the Singapore National Eye Centre (SNEC), says: “By the time one is 40, one will have presbyopia and by 45, one will need help.” The most common remedy for presbyopia is a pair of reading glasses. But now, a new, glasses-free option has popped up. The centre is offering a form of surgical procedure that it says reduces the need for such glasses and that comes with minimal side effects. Called Kamra Corneal Inlay, it has been available here since last June, says Prof Tan. The treatment originated in the United States. Clinical trials were first conducted in 2003.

There are older surgical treatments such as monovision Lasik – where one eye is corrected for far vision and the other for near vision – and presbyopic Lasik, where surgery changes the shape of the cornea to give it more than one point for focus for distance and near vision. These procedures either have side effects or do not fix the condition permanently.

Of the Kamra Corneal Inlay, Prof Tan estimates: “About 200 to 300 patients have had the surgery so far, with about 100 more on the waiting list.” The procedure starts with anaesthetic eye drops being administered onto the eye. A flap or pocket incision is created with a laser (similar to Lasik). The eye surgeon then inserts and centres the corneal inlay in the cornea of the eye, under the flap. The whole procedure takes about less than 20 minutes and the inserted inlay – a tiny black ring of 3.8mm in diameter, which is smaller than a contact lens – effectively makes the pupil smaller. “When we make the pupils smaller, the aperture or opening will increase the depth of field of the eye and improve the range of vision,” says Prof Tan, explaining that the same principle is employed in auto-focus cameras.

But the procedure, which costs $5,015 inclusive of pre-evaluative tests, surgical fees and post-surgery follow-ups, comes with limitations. Besides costing more than other surgical treatments for presbyopia available in the market that typically cost from $1,500 an eye, patients also have the corneal inlay implanted in only one eye to minimise discomfort. This is because the inlay blocks out some light that goes into the eye, making objects appear dimmer than they are.

Prof Tan says: “The inlay will be implanted on the non-dominant eye, which we can easily find out during the pre-evaluative tests. But whatever we do, there are potential side effects and some patients will also experience some degree of dry eye, glare and halo at night.” A halo effect occurs when bright objects such as a car’s headlights appear blurry against a dark background. He adds: “The benefits of Kamra inlays are permanent but the safety net is that the procedure is reversible as in the inlay can be removed.”

So far, only one patient has requested the removal of an implanted inlay. The 46-year-old man has the procedure done last August and removed the implant six months later. “His expectations from doing this operation were not fully met,” Prof Tan says. He explains: “Many people stop wearing their reading glasses completely after the procedure but we have always told patients that sometimes they need their glasses, such as when reading in very dim lighting or for a prolonged period. This patient had wanted to stop wearing glasses completely and asked for the removal when he could not do that.”

But there are those who have benefited from the new technology. Mr Alex Sia, 51, who had suffered from presbyopia since he was 40, is one of them. He underwent the procedure last year and is satisfied with the results so far. “Before the operation, I had to use reading glasses when reading technical manuals and then take them off when I work on the machines and that is very troublesome,” says Mr Sia, who owns an engineering company selling machinery. He is aware of the side effects but is not overly concerned. He says, “At worst, I will removed the implant."
  
The corneal inlay has an opening in the centre and measures 3.8mm in diameter, smaller than a contact lens. Similar to Lasik surgery, a flap is first created in the eye using laser. After that, the surgeon inserts and centres the corneal inlay in the cornea of the eye, under the flap.

However, having the option of removing the implant is not enough to allay the concerns of other eye doctors whom LifeStyle spoke to. Dr Jerry Tan, who runs his own private ophthalmology practice, points out that “if problems occur after 10 years, nobody knows whether the corneal inlay can still be removed.” He says: “I’m always worried about leaving something in the cornea because it may cause scarring but I have not seen any long-term patients who have gone through the operation. Only time will tell if it will cause problems.”

Potential problems include glare and loss of contrast in vision. Dr Tan also has no immediate plans to offer the new treatment at his clinic, telling LifeStyle that he is “watching the new technology to see how it evolves before I consider bringing it to my clinic.” Dr Julian Theng, group medical director of Eagle Eye Centre is also cautious. He says: “I need to find out more about the technology before I decide. At the moment, Kamra has still not been approved by the Food and Drug Administration in the United States, so I will wait for them to conclude the tests first.”

But Dr Tan is optimistic about the viability of Kamra Corneal Inlay as a long-term solution to presbyopia. He says: “When I started doing Lasik surgery in 1996, people also said that it will cause many problems but now Lasik is so widely accepted. So if Kamra proves to be good for patients, we will all do it. No doctor wants to harm his patients’ eyes.”