EyeWorld Asia-Pacific March 2016 Issue

51 EWAP refractive March 2016 20/25 Snellen uncorrected distance vision. “They do need to understand there is a slight reduction in contrast sensitivity at night but not nearly as much as with monovision,” Dr. Thompson said. “That is one of the things that I love about inlays: They don’t blur distance as much as monovision. As a result, there are typically less [patients] wanting them removed versus having their monovision lessened.” Another advantage of inlays— particularly for patients in their 50s—is that inlay vision doesn’t involve the amount of distance blur monovision creates to get them to read up close, which often is too powerful for good intermediate vision. One of the strong points of inlays is the intermediate vision improves along with near. With monovision, the power needed for a 55-year-old to read can make computer vision blurry. “Another powerful point we identified in our inlay research was that the longevity of the correction was much longer,” Dr. Thompson said. “We have patients who are in their upper 50s still reading great with their inlay, whereas after you induce monovision, a gradual reduction in its effectiveness occurs. So the amount of time that a patient gets a near image is variable in monovision and prolonged significantly more with inlay vision.” Dr. Thompson has identified inlay patients 8 years postop— up to 59 years old—who are still reading just as strongly at near and intermediate as they did immediately postop. An additional advantage is that inlay research has shown no reduction in stereoacuity, unlike in monovision. “Binocularity is maintained better with inlays than with monovision,” Dr. Thompson said. “I consider the inlays a nice step forward in the world of corneal correction of presbyopia.” Approved device The KAMRA inlay (AcuFocus, Irvine, Calif.), which is the only FDA approved inlay, improves near vision in plano presbyopes by increasing the depth of focus utilizing a pinhole technique. The inlay is placed in the non-dominant eye using a femtosecond laser to create a corneal pocket about 250 microns below the surface. The aperture of the inlay is 1.8 mm and its overall diameter is 3.8 mm. Unlike monovision, there is little or no effect on the patient’s binocular distance vision, stereopsis or contrast sensitivity, according to studies. “The only choice between LVC and the inlay would be the choice between LVC monovision and the KAMRA,” said Dr. Teplick, who was an investigational researcher for the device. “Monovision is a tradeoff between quality and convenience. Now that the inlay is part of our patient options, monovision is reserved for patients already happy with contact lens monovision and presbyopes with low myopic corrections who wear glasses only for driving or who don’t wear distance correction at all.” Most KAMRA patients need laser vision correction either preceding the inlay or at the same time, according to Dr. Teplick. FDA studies showed that the maximum number of patients achieving 20/20 and J3 have a postop MR of –0.50 to –0.75. “Presbyopes with this refraction do not exist commonly in nature, so we have to get them there either with LASIK preop (in our practice 1-month preop) or with LASIK/PRK at the time of KAMRA implantation,” Dr. Teplick said. EWAP Editors’ note: Dr. Thompson has financial interests with AcuFocus. Dr. Parkhurst has financial interests with ReVision Optics (Lake Forest, Calif.). Dr. Teplick had no financial interests related to this article. Contact information Parkhurst: Gregory.Parkhurst@gmail.com Teplick: teplick@europa.com Thompson: vance.thompson@vancethompsonvision.com CALENDAR OF MEETINGS 2016 DATE Meeting VENUE May 6-10 ASCRS-ASOA Symposium and Congress (ASCRS) www.ascrs.org New Orleans USA June 24-26 31st Annual Meeting of the Japanese Society of Cataract & Refractive Surgery (JSCRS) www.jscrs.org Kyoto Japan July 27-30 29th Asia-Pacific Association of Cataract and Refractive Surgeons Annual Meeting (APACRS) www.apacrs.org Bali Indonesia September 10-14 XXXIV Congress of European Society of Cataract and Refractive Surgery (ESCRS) www.escrs.org Copenhagen Denmark October 15-18 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org Chicago USA