EyeWorld Asia-Pacific June 2016 Issue

June 2016 EWAP CORNEA 53 decrease in contrast sensitivity with visual acuity is less with he Flexivue,” he said, adding that contrast visual acuity decreases in all of the inlays, as well as all of the multifocals and other intraocular lenses. “It decreases because it creates a change in the refraction from the center to the periphery,” he explained. Dr. Tamayo prefers the Flexivue because it respects the center of the cornea. “It’s a small center, but it respects this,” he said. He reserves the inlays for emmetropic patients with 20/20 distance vision who would like to correct their near vision and who are not older than age 56. “I consider the inlays as a factor to help the accommodation but not as a total replacement of accommodation,” he said. “For patients older than 56, I do not consider inlays as a solution.” A second very important factor is the patient’s willingness to lose a little bit of distance vision in the non- dominant eye in order to gain some near acuity. “Those patients who pass the test of monovision with a contact lens are the ones who I consider for this option,” he said. Comparing alternatives Dr. Tamayo pointed out that the inlay can offer a patient more distance than monovision alone can. “Real monovision implies a complete loss of distance vision in the non-dominant eye for gain in near,” Dr. Tamayo said, adding that with inlays, the loss of distance vision is less than with monovision. With inlays, this is between 10 and 25%, whereas with monovision, which puts the patient at about –2 D in the non- dominant eye, there is more than a 50% loss of distance vision. “I think that this form of modified monovision (with the inlay) is far better than the monovision that we used to do in the past,” Dr. Tamayo said. Dr. Binder concurs that inlays are for those who don’t want the loss of distance acuity. This is well-suited for those who want to be able to see up close but who still need to be able to see pretty well at distance, he noted. For instance, a plumber might benefit more from the inlay approach than a pharmacist. To help determine if a patient might benefit from the KAMRA, a pinhole can be used to help demonstrate what a patient’s distance and near vision will be like, he explained. In Dr. Binder’s view, corneal inlays offer perks over refractive lens exchange with a multifocal IOL. “The main difference would be the quality of the vision in terms of glare, halos, and dysphotopsia risks,” he said, adding that the crispness of the vision at different distances is also a factor. Dr. Binder finds that while multifocal IOLs give good quality distance vision, the near or intermediate vision can be variable and might not be as good compared to an inlay’s. This can be compounded by the fact that the adverse optical side effects at night can sometimes be worse with multifocals. While there can be some optical issues with inlays, Dr. Binder said that published literature shows that patients don’t report the optical side effects as much as they do with multifocal lenses. “Also, a big advantage with inlays is if you put a multifocal lens in and the patient doesn’t like it or it’s the wrong power, you’re stuck with either doing surgery over that lens or more commonly the lens is exchanged,” Dr. Binder said, adding that if patients don’t like the inlay, it’s simple to remove and doesn’t have the risk of going inside the eye. “On average, patients get less than 1 D of accommodation with some of the accommodative lenses,” Dr. Binder said. “If the patients don’t like the intraocular lens for whatever reason, you’re talking surgery—that’s a big disadvantage.” Presbyopia inlays - from page 51 Going forward, Dr. Binder expects the inlays to continue to make inroads in the U.S. as these wind their way through the FDA approval process. “I think the Raindrop is going to come next—I think it’s about 2 years away from submission,” Dr. Binder said. Meanwhile, the Flexivue remains behind in the approval process, and the ICOLENS doesn’t have any FDA studies ongoing. “It’s a European company so I think they’re going to stick to European sites,” he said. EWAP Editors’ note: Dr. Binder and Dr. Durrie have financial interests with AcuFocus. Dr. Tamayo has financial interests with Abbott Medical Optics (Abbott Medical Optics) and Presbia. Contact information Binder: garrett23@aol.com Durrie: ddurrie@durrievision.com Tamayo: gtvotmy@telecorp.net Films are available for viewing at the Exhibition Hall from 28 July to 30 July, 08:30 to 18:00hrs