By now it is proverbial that the Baby Boomers, the largest and richest generation in American history, have been reluctant to submit to the infirmities of age.Where technological remedies to the accretions of aging (the cottage cheese thigh, the wrinkled face, the balding head, the flagging libido) have emerged, the boomers have swiftly embraced them. They may soon embrace the elective use of intraocular lenses – artificial, surgically implanted lenses that replace the natural lens, used for decades to treat cataract patients – to retain good vision unaided by glasses or contact lenses into old age.

Each of us is heading toward the day when we will have to hold a menu at arm’s length and peer down our noses to decipher the blurred text. This is presbyopia – the “aging eye” that gradually loses its ability to focus on near things – and until recently, there was no alternative to reading glasses. With the advent of lasik surgery, some presbyopics have had a procedure called “monovision” installed, which adjusts one eye for distance and the other for reading, leaving at least one eye perpetual ly blurred. The brain readily accommodates to this in most cases, but then, for some people, sometimes not. In short, there has been no single fix to the problem without its own attendant frustration and risks.

“There’s just a huge potential market for Baby Boomers, people who are beginning to hit their late middle ages, and who won’t be satisfied with reading glasses,” said Dr. Neil Martin of Chevy Chase, Md., a spokesman for the American Association of Opthamologists. “Things that others have been simply resigned to, the boomers may want to fix if they can.”

The Crystalens, by Eyeonics Inc. of Aliso Viejo, Calif., is the newest, costliest, and, some suggest, most decisive advance in the treatment of presbyopia. Like other lenses of its kind, the Crystalens is used principally to treat cataract patients in a procedure called “clear lens extraction” – the removal and replacement of the natural lens. Unlike others, the Crystalens is “accommodative” – it fastens into place with hinges that permit the lens to mimic the natural lens’s ability to shift about and focus on near, medium, or far distances. When it works exactly as intended (about 80% of the time), a patient with an implanted Crystalens can see at any distance unaided. The Crystalens has only been approved for use by cataract patients, but doctors have already begun to experiment with its “off-label” use to treat presbyopics.

Only eight months into its launch, there are 70 surgeons that have completed certification to implant the lens. At roughly $5,000 an eye, the Crystalens remains a luxury option, and its off-label use for presbyopia is classified (along with lasik) as a form of “cosmetic” surgery that insurance companies won’t cover. This is further complicated by Medicare regulations that won’t pay for the lens and won’t let the patient pay for it out of pocket. The company is talking to the federal government to perhaps change this, said Eyeonics vice president of marketing, Mike Judy.

The surgery takes about 10 minutes, but it is more involved, and requires greater surgical skill than lasik. Though cataract surgery is the most common surgical procedure with well-established safety procedures, a very small risk of infection attends the implantation of anything artificial into the body, and the risks of infection extend to permanent blindness or death.

Dr. Sivalingam Varunan is one of two doctors in New Jersey who have completed certification in the new lens. He’s implanted about 40, with a half-dozen going to non-cataract presbyopic or heavily far-sighted patients.The results can be remarkable, he said; he has seen results that match the 80-85% success rate found in FDA clinical trials.Dr.Varunan now offers clear lens extraction as an option to presbyopes and very high myopes whose eyes might not be able to withstand the substantial reshaping of the cornea that occurs during lasik surgery.

“It’s a matter of guiding a patient to a realistic set of expectations. In some cases, the accommodative function won’t work, in which case the end result may be more like ordinary clear lens extraction,” he said.

Scott Holmquist of Brooklyn Heights fits the demographic of otherwise healthy patients looking for a surgical remedy for his aging eyes. At 43, Mr. Holmquist’s eyes have been afflicted by fairly severe hyperopia and presbyopia at once. He juggles four different pairs of glasses: one to cover large outdoor spaces; another smaller, lighter pair for going out at night when he doesn’t want to wear contacts; a set of lenses that snaps over his other glasses for reading; and another set for mid-range work. A recent flirtation with “tri-focals” just ended in frustration.”I am vain. But vanity is not the reason I’m looking into surgery. I tried the tri-focals and I just got sick of squinting through a tiny band in the middle,” he said.

Dr. Barrie Soloway of the New York Eye and Ear Infirmary is one of two doctors in New York State certified to implant the lens. He hasn’t yet implanted it into a non-cataract patient, but he expects to keep this option open amid his expanding range of treatment options.

“For cataract patients, aside from the costs, it has every indication of being a killer app – there’s no reason not to use it,” Dr.Soloway said.

The Crystalens is only the latest in a host of surgical remedies recently approved or nearing approval.Among the recent and emerging technologies is Conductive Keratectomy, which uses radiothermal waves to reshape the eye for mild hyperopes and presbyope. It relies on a modified form of monovision called “blended vision,” which is the only FDA-approved remedy for presbyopia.

There are also “Phakic” intraocular lenses, which leave the natural lens and its existing focusing capacity intact while surgically implanting a lens within the eye.The “implantable contact lens” made by STAAR Surgical of Monrovia, Calif., is placed between the iris and the crystalline lens, and the Artisan iris claw lens, made by a Dutch company, Ophtec, is attached to the front of the iris. Both are expected to be approved by the FDA later this year.

All of these procedures,as well as improvements in lasik technology, have dramatically expanded the options for refractive surgeons and patients, said Dr.Christine Javenes,director of the Laser Eye Institute at the State University of New York.

“We are very close to having a complete smorgasbord of surgical remedies to treat a range of different vision problems, from very high hyperopia and myopia to presbyopia,” she said.