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Presbyopia Challenge | Jan/Feb '15

Perspectives on Presbyopia from 35,000 feet

Traveling the world for meetings, conferences, and events can provide many varied and wonderful learning experiences. Whether we hear a new concept from the podium, engage a colleague for collaboration, or meet with industry to develop an idea, the opportunities to develop our profession can be myriad.

We may not stop and think about them often, but there is a particular group of professionals who help us in our travels and with whom we share much in common. Like surgeons, airline pilots are highly trained individuals who do precise work in controlled environments with important outcomes at stake. Their judgment and decision-making process must be impeccable, and they depend on outstanding vision to have a continual awareness of their environment.

On one occasion, I had the opportunity to talk with an active commercial airline pilot from another country about his experience with flying. He was in his 50s, and I talked about the possibility of correcting presbyopia with multifocal IOLs. Not surprisingly, he explained to me that regulations in his country prohibited commercial airline pilots from flying with multifocal IOLs. Without significant functional studies, the traditionally conservative regulatory agency ruled that the concern with halos and the loss of contrast would make it unsafe for a pilot to have multifocal IOLs.

What was surprising was his comment that, if given the choice, he would rather fly with halos around lights than to fly with the need for reading glasses. Being able to see the runway is important, but being able to see the instrumentation in the cockpit is absolutely critical. If he managed somehow to lose his reading glasses during the approach and landing process (whether due to turbulence, carelessness, or random chance), it would be very difficult for him to land the plane safely. (Thank goodness for copilots!)

Recognizing that this represents only one pilot’s opinion, I was nevertheless struck with the potential dangers and pitfalls of simply accepting old dogma. Even among young, talented, motivated, and progressive surgeons, I still meet those who routinely choose not to offer presbyopia correction with multifocal IOLs due to their concerns over quality of vision, visual side effects, increased chair time, and possible unhappy patients. As millennial (and maybe Gen-X) surgeons, we should see presbyopia—not halos, chair time, and cost—as the primary problem faced by our patients. As Jeremy Kieval, MD, discussed in the last Presbyopia Challenge column, reading glasses do not treat presbyopia; they simply help patients to cope with this progressively debilitating disease.

Surgeons with negative experiences with previous technology should reconsider their approach when new technology arrives. Industry is continually providing us with improved options for the surgical treatment of presbyopia. Most recently, Abbott Medical Optics has launched two new lenses into the Tecnis Multifocal family of IOLs. The +2.75 and +3.25 add lenses join the +4 add Tecnis Multifocal to provide surgeons more choices of where to optimize near/intermediate vision while improving the night vision symptom profile.

As our armamentarium of surgical options for the treatment of presbyopia increases, let’s be sure that our attitude toward this treatable (dare we say “curable”) disease changes as well. Even if my patients choose not to correct their presbyopia, I try my best to ensure that any patient who entrusts their vision to me will at least know of the possibility of a life free of reading glasses, bifocals, and the debilitating effects of presbyopia.