Researchers studying the human eye have long been puzzled by the condition of presbyopia. It has plagued millions, yet it has been difficult to firmly establish exactly why it occurs and how it might be effectively treated. However, new schools of thought may have produced a solution to the presbyopic dilemma.

NEW BALANCED VISION™ for Presbyopia

Have you noticed that your newspaper, menu, and watch have been getting blurrier lately? Do you find yourself holding things farther and farther away in order to see them clearly? You are most likely struggling with the effects of presbyopia, an age-related eye condition that affects 4 out of 5 adults over age 40. If so, would you like to rejuvenate and prolong the "youth" of the natural focusing mechanism of your eyes, eliminate or decrease your dependency on reading glasses, and restore "NEW BALANCED VISION"™ to both eyes for near, intermediate, and distance vision? "NEW BALANCED VISION"™ (parts1 & 2) may play an important role in partially solving this perplexing problem of aging.

Researchers studying the human eye have long been puzzled by the condition of presbyopia. It has plagued millions, yet it has been difficult to firmly establish exactly why it occurs and how it might be effectively treated. However, new schools of thought may have produced a partial solution to the presbyopic dilemma. This comes in the form "NEW BALANCED VISION"™ (parts 1 & 2) where part 1 is LASIK or PRK-HYPERPROLATE™ (LASIK or PRK-HP™) performed with EXCIMER LASER CUSTOM LASIK or PRK and part 2 is LASER-PresBioptics™ (LASER-P™) performed with a state-of-the-art 2.94 Erbium YAG laser (Infra-Red spectrum).

We have done clinical studies in Juarez, Mexico since 2002 on a revolutionary procedure that we refer to as "NEW BALANCED VISION"™ parts 1 & 2 to correct near, intermediate, and distance vision in both eyes. Part 1, or LASIK or PRK-HYPERPROLATE™ (LASIK or PRK-HP™) of the procedure utilizes the excimer laser with what we refer to as CUSTOM LASIK or PRK to balance the eyes in such a way that "neural adaptation" can take place. "Neural adaptation" occurs over time between the brain and the new change in curvature and power of the eyes through which the brain accepts and balances vision for near, intermediate, and distance. In the "NEW BALANCED VISION"™ part 1 approach, we attempt to increase depth of focus or depth of field by allowing a larger peripheral corneal treatment zone with more corneal peripheral laser treatment where by the peripheral curve of the cornea becomes progressively flatter and the central curve becomes progressively steeper. We refer to the reshaped cornea as a "prolate" or "hyper-prolate" cornea following most of these laser treatments. This in turn, allows the central cornea to retain more power or magnification for near and intermediate vision (arms-length vision) along with an improvement in depth of field. Simultaneously, there is a decrease in the most common higher order aberration of the cornea called positive spherical aberration. The appropriately selected eye remains "slightly" myopic or nearsighted to allow additional magnification for even better near and intermediate vision. We refer to this portion of the operation as "Progressive Blended Vision" where by the brain balances the two eyes when binocular vision is stimulated and therefore retains stereopsis or 3-D vision. The CUSTOM LASIK or PRK procedure is performed bilaterally in most cases but unilaterally in some, so that most of our patients are able to regain or restore "NEW BALANCED VISION"™ binocularly for near, intermediate, and distance vision. This has been a huge breakthrough for most of our presbyopic patients. By combining these revolutionary surgical techniques we are able to essentially avoid "mono-vision", which makes one eye vs. the other much more myopic and the brain has a much more difficult time trying to balance the vision. Our goal with "NEW BALANCED VISION"™ part 1 for the patient with the aging eye or presbyopia is to correct distance, intermediate, and near vision to the degree where the brain adapts and maintains improved binocular vision at all levels, increases depth of field, maintains stereopsis or 3-D vision, and balances binocular vision while simultaneously viewing an object. We know that the cornea or front surface of the eye is responsible for about 2/3rds of the focusing optical power of the entire eye, and it is the corneal power and shape that we are changing with the CUSTOM LASIK or PRK laser treatment. The cornea is the fixed, non-mobile optical portion of the eye that normally doesn’t continue to change substantially as one gets older, once it undergoes laser treatment it will generally stabilize in 6 months to a year, for the most part, and once stable it normally does not change significantly the rest of your life.

The second most important optical system in the eye is the CRYSTALLINE LENS- ZONULE-CILIARY MUSCLE COMPLEX, or focusing apparatus. The CRYSTALLINE LENS is responsible for approximately 1/3 of the optical power of the eye and is considered to be a mobile system, which is constantly adjusting and changing shape and power in order to keep the eyes focused in a seamless fashion as one looks at objects at varying distances from near to far or from far to near. The size of the pupil, or black hole in the colored part of the eye is determined by light exposure and focusing distances. It is smaller in bright light conditions and larger in dim light conditions. It becomes smaller when looking at a close object and becomes larger when viewing an object at distance. The tiny muscles in the iris or colored part of the eye that control the size of the pupil at any given time are in sync with the entire focusing apparatus at any given time. Also, very importantly, this focusing apparatus is extremely vulnerable to aging, and the focusing ability of the CRYSTALLINE LENS is continually weakening in its ability to focus for near objects as we age. This is the reason that we have to continually push our reading material further and further away from our eyes in order to see it clearly as we reach 40 years and beyond. At age 65 or 70 the natural CRYSTALLINE LENS can no longer focus at all and becomes a fixed, non-mobile optical structure like the CORNEA. We like to think of the CRYSTALLINE LENS as developing a "partial paralysis" as we age, and when we reach 65 to 70 years of age, it becomes "totally paralyzed" and this is the reason patients require not only bifocals but also trifocals to see near and intermediate objects.

Just to re-cap: Presbyopia makes seeing near objects more difficult and also makes it more difficult to adjust from distance to near vision and back again. The word "presby" refers to something old or aging and "opia" refers to the eye or oculus. In the past, presbyopia was believed to be caused by a general loss of flexibility in the CRYSTALLINE LENS (focusing lens) in the eye. More recently, however, ophthalmologists have begun to consider an alternate view of presbyopia. In the newer school of thought, the problem is thought to lie in the fact that the CRYSTALLINE LENS of the eye continues to grow (albeit very slowly) throughout our lives and eventually becomes crowded within it’s own occupying space. As the lens grows, it crowds the surrounding ciliary muscle (focusing muscle within the eye), making it more difficult for the lens to adjust itself for seeing near objects. In addition, as we age, the surrounding white coat of the eye (sclera) tends to stiffen and compress the underlying focusing mechanism, resulting in restricted mobility. Furthermore, the aging sclera may also inhibit the maximal contraction of the ciliary muscle complex, thus, limiting the focusing ability of the CRYSTALLINE LENS for near objects and slowing down the circulation of the nutrient rich aqueous humor, which nourishes the delicate intra-ocular structures. This explanation serves as an introduction to " NEW BALANCED VISION"™ part 2, in which Dr. Maddox uses a state-of-the-art 2.94 Erbium YAG laser (Infra-Red spectrum) to make tiny scleral relaxing ablation patterns in the four quadrants of the aging and less elastic sclera. We hypothesize that by making a strategic series of scleral-relaxing ablation patterns in the four scleral quadrants, the patient may not only be able to actively increase the power of the CRYSTALLINE LENS, or focusing lens of the eye but may also be increasing the circulation of important nutrients and fluids to and from the vital structures inside the eye that lie under this aging scleral coat of the eye. Therefore, by relaxing the aging sclera with these 4 quadrant laser ablation treatments, we believe that we can improve the efficiency and mobility of the ciliary muscle that is attached to the inside of the sclera 360 degrees, thereby improving and strengthening the dynamic focusing mechanism of the eye that continues to progressively weaken as we age. This translates into partial restoration of the natural dynamic focusing function of the eye that enables us to see near, intermediate, and distant objects. This decreases our dependence on artificial optical aides such as reading glasses for near and intermediate vision. Even if we have to use reading glasses for fine print like news paper, telephone book print, or smaller, the power of the reading glasses is usually about ½ the power of the reading glasses or bifocal that you used prior to your surgery. Hence, the "NEW BALANCED VISION"™ part 2 attempts to address the second most powerful optical structure in the eye, whose focusing function is negatively influenced by the aging process. The goal here is to rejuvenate and strengthen the aging and weakened focusing mechanism within the eye.

Normally, "NEW BALANCED VISION"™ part 1, or LASIK or PRK-HYPERPROLATE™ (LASIK or PRK-HP™) utilizing CUSTOM LASIK or PRK, is employed first and this will help a great deal in reducing your dependence on glasses for near, intermediate, and distance vision. A small percentage of patients will need an enhancement or fine-tuning of the vision with CUSTOM LASIK or PRK within the first year. We find that the bulk of the near, intermediate, and distance vision correction is achieved with "NEW BALANCED VISION"™ part 1 and smaller but significant portion of the near vision is improved with the "NEW BALANCED VISION"™ part 2. We do find that the maximum benefit for improving near, intermediate, and distance vision occurs when both "NEW BALANCED VISION"™ part 1 and part 2 are performed. Part 2 is like having cake with icing on top and part 1 is like the cake without the icing. We are recommending the combined procedure in the majority of cases in order to get maximum benefit and more stable long-term results.

If one decides to go on to "NEW BALANCED VISION"™ part 2, it is will be performed between 3 months post-op "NEW BALANCED VISION"™ part 1 up to 1 year. Part 2 is considered as a completely separate procedure from "NEW BALANCED VISION"™ part 1, just as with the cake and icing analogy.

The "NEW BALANCED VISION"™ part 1 & 2 procedures are incredibly exciting. If you are tired of constantly having to wear glasses or struggle to see close up most of the time, "NEW BALANCED VISION"™ part 1 alone or even better, combined with "NEW BALANCED VISION"™ part 2 may be for you. Please contact Dr. Maddox today or call the office at 915-881-8100 to find out whether you are a candidate.

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