New Hope for Aging Eyes

Glaucoma

The problem

Fluid circulating in the eye maintains healthy pressure levels because the excess drains through a meshwork of outflow canals. If this meshwork falters and fluid builds up, pressure in the eye can damage the optic nerve and lead to vision loss. Not every patient responds to current medications, however, and traditional glaucoma surgeries are major procedures with rare but potentially serious side effects.

New hope

Breakthrough meds: Vyzulta, approved by the FDA in November 2017, belongs to an existing class of drugs called prostaglandin analogs and works by releasing nitric oxide, providing a dual action to lower pressure in the eye. Rhopressa, recently approved, belongs to a new class of medicines called Rho kinase inhibitors; they target cells in the eye’s drainage meshwork to restore outflow. 

Microinvasive glaucoma surgery (MIGS) is a relatively new development that, while not always as effective as traditional glaucoma surgery, causes less trauma and has fewer side effects. The FDA-approved iStent, a tiny tube that restores the traditional outflow of fluid through the eye’s drainage meshwork, is implanted using an incision so small that surgeons view it through a microscope. (An even smaller version, the iStent inject, has recently received FDA approval.) The similar CyPass Micro-Stent opens a fluid pathway through a different channel. Both are installed at the time of cataract surgery, so the added surgery risk is even smaller.

Macular Degeneration

The problem

Age-related macular degeneration (AMD) has a genetic component, but weight gain, smoking and not wearing sunglasses are among the lifestyle factors that increase your risk for the disease. It occurs when the macula — the central portion of the light-sensing retina at the back of the eye — becomes damaged, resulting in distortion and vision loss in the center of your field of view. In the “wet” form of the disease, leaky blood vessels and scar tissue can dramatically accelerate vision loss. Taking AREDS2 supplements (a combo of vitamins C and E, zinc, copper, lutein and zeaxanthin) may slow the disease’s progression. For wet AMD, regular injections of drugs into the eye can inhibit a protein called vascular endothelial growth factor (VEGF), which promotes the growth of abnormal blood vessels. There are also surgical options available. But these treatments can only slow, not stop, the progression of AMD, which can result in severe blindness. 

New hope

 

Gene therapy: We’re nearing the day when genetic causes of diseases such as AMD can be prevented or cured with gene editing. “A deactivated virus loaded with a corrected gene would penetrate cells and insert new code into your DNA like a cut-and-paste on your computer,” Haller explains. In December 2017, the FDA approved this approach for a disease that causes blindness in children — the first gene therapy for any inherited disease. Experts foresee major progress in the next decade, perhaps even programming the body to create its own ­anti-VEGF medication.

Next-gen stem cells: You’ve heard of embryonic stem cells — and the controversies about using them. Now there’s a different category of cells that can be derived from your own body and used to grow a variety of new cells and tissues, including specific retinal cells that go bad in macular degeneration. A commercially available therapy could arrive within 10 years.

An eye telescope: This is the first and only FDA-approved surgical device for people who have end-stage macular degeneration. One eye’s lens gets replaced with the tiny Implantable Miniature Telescope, which magnifies the field of view and improves central vision. The device is currently limited to those who haven’t undergone cataract surgery, but a new study is investigating whether swapping the telescope for a previously installed intraocular lens can safely help patients.

Dry Eye

The problem

With age, glands in the eyes produce fewer tears, as well as fewer oils that prevent tears from evaporating. More than 16 million Americans suffer symptoms; the problem is especially common in women. Over-the-counter artificial tears may help. Otherwise, doctors can prescribe anti-inflammatory eye drops to help restore glands to normal function, but these treatments aren’t effective in all people and can take months to work. Another option is for a doctor to insert small plastic plugs in the corner of each eyelid near the nose to help hold tears in the eyes.

New hope

 

Game-changing medications: Xiidra (lifitegrast) is a topical drug that treats eye inflammation by blocking a specific antigen. “It can have an effect in as early as two weeks,” says Terry Kim, an ophthalmologist at the Duke University School of Medicine. Coming soon is an eye drop with lubricin, a complex glycoprotein with novel lubricating properties.

Gland aid: The LipiFlow Thermal Pulsation System works to clear glands lining the eyelids and improve oil secretions. During an in-office procedure, a device applies pulsing heat and pressure to the eyelid, liquefying and pushing obstructions out of the gland while protecting the eye. Patients in a small Harvard study reported improved symptoms up to three years after a single 12-minute treatment.

 

Eye treatment through the nose: The TrueTear Intranasal Tear Neurostimulator — a handheld device that delivers tingling energy pulses into your nose — triggers natural tear production. In a study, it significantly increased tear output in 97 patients with moderate to severe dry eye.

Implantable eye drops: Dry eye can be tough to treat, partly because people get tired of putting in eye drops. Systems under development would allow deposits of medication to be implanted in eyes for gradual release over a period of months. Also, researchers are investigating ways to formulate drugs using tiny nanoparticles that could penetrate better so you don’t have to use them as often.

Near- or Farsightedness

The problem

Lenses lose flexibility over time, so they’re less able to change shape to focus on different distances. 

New hope

Light-changing inlays: Inlays are implanted under the cornea to change light before it reaches the lens. The Kamra inlay uses a pinhole to sharpen focus in a way that’s similar to closing the aperture of a camera. “Inlays are a new category of devices that may minimize the need for reading glasses,” ophthalmologist Tal Raviv says.

Eye-training programs: Preliminary research suggests that staring at fuzzy lines called Gabor patches for 30 minutes a few times a week can train the brain to see better up close. Some ophthalmologists say you shouldn’t get your hopes up, but the ­GlassesOff app for iOS and Android devices ($25 for three months) provides easy access to a similar program that claims to sharpen newspaper-size print after three months.

Richard Laliberte, an award-winning health journalist, has written or coauthored five books.