This story is part of a series on the current progression in Regenerative Medicine. This piece is part of a series dedicated to the eye and improvements in restoring vision.
In 1999, I defined regenerative medicine as the collection of interventions that restore to normal function tissues and organs that have been damaged by disease, injured by trauma, or worn by time. I include a full spectrum of chemical, gene, and protein-based medicines, cell-based therapies, and biomechanical interventions that achieve that goal.
The eye is a complex organ that gives us a window into the world around us. Yet, over 2 billion people around the globe have impairments that dramatically affect their ability to see near or far. One billion of those people have issues with vision that could have been prevented or not addressed.
The personal impacts of vision impairments are significant. Whether young or old, struggling with sight can impact the quality of life. In children, unaddressed refractive disorders can lead to delayed motor development. Adults can also face higher rates of unemployment and depression in relation to their challenges seeing clearly. Older adults experience significant personal impacts from vision impairment and loss, such as social isolation and a higher risk of falls and injury.
Over 84 million people struggle with refractive errors specifically. These errors arise when the shape of your eye hampers the proper focus of light on the retina, a light-sensitive tissue layer at the back of your eye. Four main types of refractive errors affect vision: myopia, hyperopia, astigmatism, and presbyopia. They can cause various symptoms, including blurry vision, double vision, headaches, squinting, eye strain, and eye pain.
Treatments for refractive issues range from glasses to contact lenses to corrective surgeries like LASIK. Each treatment comes with a host of pros and cons. It’s essential to recognize the significance of eye disorders, particularly refractive issues, as they are one of the most prevalent eye issues globally. The first step to correcting vision problems is understanding them.
More on Sightedness, Astigmatism, and Presbyopia
You may have heard of nearsightedness and farsightedness, which cause blurry vision at different distances due to an imbalance in how the eye focuses light. Each type of sightedness and astigmatisms result in other challenges and characteristics.
Myopia, or nearsightedness, makes it difficult to see distant objects. It occurs when the eye is too long, causing light entering your eye to focus in front of your retina instead of directly on it. This results in a blurry image being transmitted to your brain. Myopia is usually corrected by wearing glasses or contact lenses with concave (curved inward) lenses to bend the light.
Conversely, hyperopia, or farsightedness, makes it hard to see close-up objects clearly. This type of sightedness is caused by an eye that is too short and causes light entering the eye to focus behind the retina instead of directly on it again, resulting in a blurry image. Hyperopia can be corrected with glasses or contacts with convex (curved outward) lenses.
People with astigmatism may experience blurry or distorted vision for objects far away and nearby due to the cornea or lens having an abnormal shape. Astigmatism can be present at birth or develop during childhood or young adulthood and is often accompanied by nearsightedness or farsightedness. Astigmatism is usually corrected with glasses. Contact lenses can also correct this condition though they tend to be more expensive and take longer to receive than lenses designed for myopia or hyperopia.
Presbyopia is a common refractive error among middle-aged and older adults that affects near vision. According to the World Health Organization, approximately 826 million presbyopia cases exist worldwide, making it one of the leading causes of vision issues. It occurs when the lens in the eye loses flexibility with age, making it difficult to focus on close objects. Those with presbyopia often use bifocal or multifocal lenses to help with distance and near vision.
Standard Treatment Options for Blurry Vision
The standard treatment for refractive vision errors is glasses and contacts. Today, many of us wear glasses, whether for fashion or necessity. Americans spend over $15 billion annually on eyewear in the US.
The origins of glasses and refractive lenses date back to ancient civilizations such as the Egyptians and Romans, who used polished stone or crystal lenses to magnify objects. While these early lenses lacked the corrective power of modern lenses, they paved the way for clear vision for many people.
Eye doctors prescribe precise lens dimensions for glasses to improve vision clarity. Glasses come in various styles and can be customized with plastic, metal, or titanium. Different lens styles include single-vision plastic to multifocal HD options. However, glasses can be expensive and prone to smudging, fogging, scratching, and breaking. Hence, eyeglasses are not the only option for individuals with vision impairments.
Contact lenses are a popular alternative to glasses and have come a long way since their invention in the late 1800s. While early contact lenses were made of glass, modern lenses are much smaller and more comfortable. They sit directly on the surface of your eye and correct how light enters the retina. They also offer better peripheral vision than glasses. Contact lenses can be used for nearsightedness, farsightedness, astigmatism, and presbyopia. However, the lenses for astigmatism and presbyopia come with a more significant price tag and must be oriented correctly in the eye.
There are also more permanent solutions to refractive problems, like surgery. Refractive surgery offers an effective solution to reduce or even eliminate the glasses or contact lenses requirement. Different refractive surgeries, such as LASIK (laser-assisted in situ keratomileusis), are available, which reshape the cornea to correct the refractive error.
Looking at LASIK
LASIK, or laser-assisted in situ keratomileusis, is a refractive surgery to correct vision problems. It is the most widely performed surgery for refractive errors. Around 25 million people have undergone LASIK surgery since it became a steadfast treatment in 1989.
The surgery is usually done as an outpatient procedure and takes about 10-15 minutes per eye. During the process, numbing eye drops ensure patient comfort. Most people experience improved vision immediately or within a day or two after surgery, which is generally painless.
LASIK surgery starts by creating a corneal flap wherein the surgeon delicately forms a thin, hinged layer on the cornea’s surface using a laser. This meticulously crafted flap unveils the underlying corneal tissue. From here, the surgeon can precisely remove exact amounts of corneal tissue using computer-guided laser eye mapping to correct refractive errors.
Once the cornea has been reshaped, the surgeon delicately repositions the flap back over the eye without stitches. This flap will act as a protective bandage, helping to speed up the healing process and ensuring optimal recovery. This natural corneal healing highlights one of the more significant concepts of regenerative medicine – the body healing itself.
Success rates for these surgeries are significant at 96%, yet there is still a decline in patients opting for these elective procedures. An important factor in deciding whether to undergo LASIK surgery is fear. It isn’t surprising that many of us fear anything coming in contact with our eyes, and the idea of a laser being used on our eyes while we are awake and watching is too much to bear for some.
Another significant factor is cost. LASIK prices vary, but generally, it costs roughly $4,400 for both eyes to be treated in the United States. While the cost of LASIK has decreased in recent years, other economic factors have also changed. These financial challenges put the surgery out of reach for a large portion of the population.
Future Leads to New Options
The future of refractive error treatments for the eye is promising, with ongoing research and development of new technologies and procedures. One advance to keep an eye on is customized corneal ablation surgery or advanced surface ablation. This type of refractive surgery uses advanced imaging technology to create a personalized treatment plan for each patient. A laser reshapes the cornea by mapping its unique shape and curvature, similar to LASIK. This corneal ablation surgery provides an option for long-term relief for those not candidates for LASIK.
The future of refractive error treatments is filled with promise thanks to advances in technology and research. Although eyeglasses, contact lenses, and refractive surgery have been successful, we can look forward to new and improved treatments for refractive errors.
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