5 Revolutions in Vision

A new way to diagnose glaucoma

As we age, nerve fibers may be damaged by a buildup of fluid that exerts pressure within the eye, resulting in a loss of peripheral vision. More than two million Americans are diagnosed with this condition—called glaucoma—each year, often after permanent vision loss has occurred. Now, new technology allows doctors to capture an image of the optical nerve fibers, detecting damage before pressure builds and symptoms appear. "We want to find early damage to the nerve fibers and begin treatment before any vision is lost," says Dr. Steven Odrich, an assistant professor of clinical ophthalmology at Columbia University.

Major advances in laser surgery

Refractive (or laser) eye surgery has been used to correct nearsightedness, farsightedness, and astigmatism for more than 30 years, and new technology is making the procedure even safer. LASIK (laser assisted in-situ keratomileusis) is the most common form of laser surgery, followed by PRK (photorefractive keratectomy). Each uses lasers to change the shape of the cornea.

In PRK, an eye surgeon completely removes the top layer of the cornea. With LASIK, a hinged flap is surgically created to get to the middle layer, where the correction in vision is made. A new diagnostic tool called "wavefront technology" creates a map of the eye, allowing doctors to diagnose and treat vision problems with more precision. If you have LASIK surgery, a new type of laser (called a femtosecond laser) has been developed to make an exact point of entry to the middle cornea.

Better lenses for cataracts

When the lens of your eye becomes cloudy and vision is impaired, you may need cataract surgery. The lens of the eye is removed and replaced with an artificial one, called an intraocular lens (IOL). The procedure—one of the most popular and safest in use today—was developed after World War II, when doctors noticed that plastic fragments lodged in the eyes of bomber pilots did not cause inflammation. Eye surgeons then developed lenses that could be placed directly into the eye to restore vision, but only for distance.

Today, the latest IOLs imitate multi-use glasses like bifocals and trifocals, which allow the wearer to see at a distance, up close, and in between. Similar IOLs even have been approved by the FDA for use in patients with extreme nearsightedness that is not caused by cataracts.

New research on macular degeneration

Age-related macular degeneration, the most common cause of vision loss for people over 55, occurs when either leaky blood vessels ("wet") or other debris ("dry") cloud the macula, a tiny part of the eye responsible for 80 percent of vision. Laser surgery now can be used to treat the first type, and two new drugs injected into the gel behind the lens can help restore vision. For "dry" macular degeneration, new research from the National Eye Institute shows that dietary supplements with high levels of vitamins C, and E, along with beta-carotene and zinc, can minimize effects by 25 percent.

A clearer picture

Some ophthalmologists use digital retinal photography to more easily and accurately diagnose eye disease. Using high-resolution lenses and magnifiers, these cameras are able to observe and record nerve damage caused by a buildup of pressure in the eye (glaucoma) as well as a host of other eye problems that could lead to loss of vision if untreated.