EyeWorld Asia-Pacific September 2016 Issue

42 EWAP SECONDARY FEATURE September 2016 logMAR or better from 0 D to –3.0 D of defocus, but trifocal IOLs showed a more continuous range of defocus. Pinhole vision Another option for presbyopia correction is the corneal inlay. Corneal inlays for the treatment of presbyopia have evolved along three branches: space-occupying lenticules to create hyperprolate corneas; refractive annular add lenticules; and small aperture inlays that use the pinhole effect. visual acuity in some subjects, but long-term follow-up is needed for careful evaluation. In his own experience, Dr. Tchah said that while visual outcomes tended to be good, patient satisfaction tended to be less so, in part due to visual symptoms such as glare and halo and, as demonstrated by one particular patient Dr. Tchah shared, a sharp drop in night vision. That said, Dr. Tchah acknowledged the evolution the technology has seen and continues to see. “Will the future be brighter?” he asked. “We will see.” Best of both worlds One question that was raised early during the symposium was, given the amount of history we’ve had with bifocal, trifocal, and the entire range of multifocal presbyopia-correcting IOLs, why hasn’t the penetration been better? cataract continues to grow—the use of presbyopia-correcting IOLs on the other hand has remained flat. This is particularly baffling in light of survey data that says that, in patients aged 55-95 years, 85% were interested in becoming less dependent on spectacles at the time of surgery. According to surveys, most surgeons ascribe this low penetrance to the cost of multifocal IOLs, but Dr. Solomon disagrees. “I don’t think it’s cost,” he said. “I think it’s quality of vision.” In addition to the difficulty of hitting refractive targets with multifocals on the surgeon’s side, Dr. Solomon cited the unpredictability of patient satisfaction with multifocal IOLs. Despite this, surgeons have not been ignoring presbyopia; however, rather than multifocal IOLs, Dr. Solomon said that 22.3% of ASCRS cataract surgery patients are targeted for monovision— making monovision 2 to 4 times more frequently employed than any other presbyopia treatment. Why should this be the case? Monovision, Dr. Solomon said, “isn’t a very sexy topic.” Dr. Solomon had a simple answer: “Quality of vision rules.” “Splitting light in any way shape or form has to detract from quality of vision,” he said. And while no presbyopia solution gives “everything,” he said that monovision “provides ‘the most’ solution with the least downside.” Moreover, Dr. Solomon believes that extended depth of focus IOLs will likely increase the use of monovision. Stretching the point Intermediate vision appears as important as or even more so than near vision, Oliver Findl, MD, PhD , Vienna, Austria, said. For activities such as using the computer, shopping, and many hobbies, using reading glasses is “not a major impairment.” Quality - from page 41 Hungwon Tchah, MD , Seoul, South Korea, shared his personal experience implanting the KAMRA pinhole inlay (AcuFocus, Inc., Irvine, Calif.). The inlay has been approved by both the U.S. Food and Drug Administration (FDA) and European Medicines Agency (EMA). “Both global and FDA study results show that improved near visual acuity after corneal inlay maintained up to 3–5 years,” he said. He said that some adverse effects occurred in more than 1% in the FDA study, and over 30% of subjects reported some degree of visual symptoms. The majority of effects and symptoms, however, were mild. Foreign body reaction and wound healing which induce haze could be a main cause of decreased best-corrected distance Around the world, Dr. Solomon said, only 6-9% of implants are presbyopia-correcting IOLs—less than 1 in 10 patients, he said, are actually receiving them. Bringing that fact further into perspective, he cited projections that show that cataract surgery procedures have been growing and will continue to grow well into 2020; meanwhile, despite all the controversy surrounding the procedure, femtosecond laser Going back over the options presented by the speakers before him, Dr. Findl said that monovision is for intermediate range of vision. Meanwhile, dysphotopsias are unavoidable with the multiple foci of multifocal IOLs—these IOLs he said “must have haloes by definition”— although, he added, not all patients are disturbed. Dr. Findl asked, where does the extended depth of focus (EDOF) lens come in? The idea, he said, is to combine the new generation lens with micro-monovision. Sharing data from 3 months clinical experience in 146 bilaterally implanted patients, Dr. Findl said that EDOF IOLs provided good binocular uncorrected distance and intermediate visual acuity with micro-monovision of about 0.50 D. There was a high degree of spectacle independence and little to no dysphotopsia. Patients did need reading glasses for long-time reading,