New surgical implant for presbyopia

There have been numerous times whenI have joked with a patient that if we could find a cure for presbyopia (a refractive condition where near vision is compromised due to aging and stiffening of the lens) that didn't involve glasses, we would be rich.  According to the UK Telegraph, researchers are claiming they have done just that with a surgical implant procedure called Z Kamra.  This $6000 procedure (per eye!) involves lifting a flap off the cornea and placing a small implant underneath that functions like a pinhole. The result of this pinhole is that only central beams of light pass through the lens to the retina, creating a clear image.  It is a technique commonly used by optometrists to check visual potential.  The pinhole cuts out stray information, and the patient will be able to see clearly without glasses when viewing through the small hole.  

Well, you might be thinking, if pinholes have been around so long, why haven't doctors been utilizing them already?  Type pinhole glasses into your browser and you'll find a number of internet entrepreneurs trying to cash in on this concept.  Take the below glasses for example:

Pinhole glasses for sale at pinhole-glasses.com.  Your vision will be clear, but obviously limited.

Do you notice a problem?  You are looking through a solid black surface, albeit with a lot of pinholes, but you are going to be obstructing almost your entire field of view!  Try wearing these at night, and it is a car accident waiting to happen.  The makers of the Z Kamra procedures admit that reduction in night vision is a side effect of the procedure, but apparently results in Britain have been positive thus far.  The procedure is not yet approved for use in America.  

My take: I'm skeptical that the clarity of vision will be enough to overcome the drawbacks of reducing the amount of light that enters the eye through the pinhole in conditions like night driving.  With more and more people unsatisfied with presbyopic correction from glasses and contact lenses however, the market is ripe for someone to create a good surgical option.  If this procedure (or any other) does prove to be safe and effective, I imagine it will eclipse even LASIK correction very quickly.  I will be on the outlook for any more information, and be providing more information about what exactly presbyopia is very soon!