EyeWorld Asia-Pacific September 2013 Issue

51 EWAP rEfrActivE September 2013 Artist’s rendering of the Raindrop inlay Source: ReVision Optics The KAMRA corneal inlay Source: AcuFocus A slitlamp image of the Presbia Flexivue Microlens under retroillumination Source: Presbia Corneal inlays have the potential to ‘treat millions’ by Michelle Dalton EyeWorld contributing Writer All that’s needed is U.S. regulatory approval, most surgeons say C orneal inlays are designed to treat presbyopia by being inserted in the nondominant eye and correcting for near vision; distance vision remains (mostly) unaffected. Three devices are currently under investigation in the U.S., with the AcuFocus (Irvine, Calif., USA) KAMRA inlay already filed for regulatory approval. The remaining two devices—the ReVision Optics (Laguna Hills, Calif., USA) Raindrop and the Presbia Flexivue Microlens (Presbia, Amsterdam)—are in trials. “It probably doesn’t matter which inlay is first to market,” said John A. Hovanesian, MD, faculty member, Jules Stein Eye Institute, Los Angeles, Calif., USA. “When we talk to patients who are presbyopic, many who have heard of monovision are just not interested. They love the idea that they can get an implant that gives them near vision without the compromises of distance vision.” The inlay market overall “is very promising,” said George O. Waring IV, MD , assistant professor of ophthalmology, director of refractive surgery, Storm Eye Institute, and medical director, Magill Vision Center, Medical University of South Carolina, Charleston, SC, USA. “In a global depressed economy, outside the U.S. it’s the inlays that have increased volume for practices.” Further, since “100% of people get presbyopia, there is a huge market opportunity as patients are not aging gracefully anymore,” Dr. Waring said. “Some of my most motivated patients are new presbyopes who never had to wear glasses before.” Inlays “will be a game changer for those who get involved with it and are not afraid to make a flap or a pocket (or probably both),” said Jeffrey Whitman, MD, president and chief surgeon, Key-Whitman Eye Center, Dallas, Texas, USA. “We’re going to have a whole new range of products for the presbyope; if the patient really dislikes the inlay, we can remove it and the patient returns to preop vision.” The “ideal” inlay candidate is someone in the 50- to 60-year- old range, said Cees Verdoorn, MD, medical director, Lasik Centrum Oogkliniek, Boxtel, the Netherlands. He explains to patients that the inlay is a “spacer” that’s placed into the cornea to make it steeper in the center. “This has to be a very precise placement, or the patient may end up with blurred vision,” he said. Dr. Hovanesian said both the Raindrop and the KAMRA seem to improve distance vision to about 20/25, with near vision close to J1 or J2. Drawbacks to the technology include the potential for decentration and the possibility that the patient may have a foreign body sensation, Dr. Whitman said. Prior LASiK patients People who had previously undergone LASIK are as viable candidates as those who have never had surgery, Dr. Hovanesian said. “Just go beneath the flap that already exists to place the inlay,” he said. “For the KAMRA, the technique involves making a pocket, and the other inlays will probably follow suit. Assuming the cornea is thick enough to have some space, the small pocket is unlikely to cause significant damage to the first flap, particularly continued on page 52