EyeWorld Asia-Pacific June 2016 Issue

54 EWAP CORNEA June 2016 by Liz Hillman EyeWorld Staff Writer The ins and outs of intracorneal inlays What you need to know about this surgical option for correcting presbyopia E ach week, 1 or 2 patients ask John Hovanesian, MD , clinical instructor, Jules Stein Eye Institute, University of California, Los Angeles, how they could be freed from a dependence on reading glasses. He said he can appreciate their plight all the more now that he, admittedly, has joined the age group where presbyopia begins, prompting a reliance on some form of correction for near vision even for people who never needed glasses or contacts before. Corrective options beyond readers include monovision LASIK, monovision contact lenses, and multifocal or accommodating IOLs, but some patients might not consider these attractive alternatives to readers, Dr. Hovanesian said. “Most people have a bias against monovision—it just sounds unnatural to them—even though it’s a good strategy,” he said. As of April 2015, another alternative hit the market that might fill this gap: intracorneal inlays. The first and only inlay currently approved by the U.S. Retroillumination image of the Raindrop inlay in a human eye Source: John Hovanesian, MD A laser technician who has worked closely with Dr. Wiley, operating excimer lasers for nearly 20 years, recently had the KAMRA inlay placed in his right eye. Source: William Wiley, MD Food and Drug Administration (FDA) is the KAMRA (AcuFocus, Irvine, Calif.), which uses a small aperture effect to increase depth of focus. Other inlays with investigational status in the U.S. include the Raindrop (ReVision Optics, Lake Forest, Calif.) and Flexivue Microlens (Presbia, Dublin). Like other presbyopia- correcting options, inlays have their own unique set of advantages and some disadvantages, and there are pros and cons among the different types of inlays, making patient selection a key factor for success. Ultimately though, William Wiley, MD , medical director, Cleveland Eye Clinic said he thinks ophthalmologists will benefit from them as another tool to give patients more choices to reach their desired refractive outcomes. “What’s nice is [inlays are] a dynamic solution for a dynamic problem,” Dr. Wiley said, explaining that they age well as patient vision changes over time. What are the options? The KAMRA, which some practices are just starting to offer, uses the same optical principle as that used in a disposable camera, said Richard Lindstrom, MD , adjunct professor emeritus,