EyeWorld Asia-Pacific June 2017 Issue

EWAP FEATURE 15 June 2017 Slit lamp picture of a KAMRA inlay 1 year after implantation. Source (all): Damien Gatinel, MD, PhD Weighing the pros and cons of inlays by Vanessa Caceres EyeWorld Contributing Writer They provide another option for presbyopic patients, but careful patient selection is crucial I nlays offer another option to patients of presbyopic age. As surgeons garner more experience with this technology, they get a better sense of the pros and cons of inlays. On the pro side One major advantage of inlays is that they provide a near vision solution for a universal vision problem, said John Vukich, MD , adjunct associate clinical professor, University of Wisconsin Madison School of Medicine. Although the need for better near vision has always been important, that need has increased substantially with today’s ubiquitous smartphone and computer screens. AT A GLANCE • Inlays provide another option for presbyopic patients, who must increasingly use their near vision in everyday tasks, including for smartphone use. • Inlays are reversible; they also can be used after cataract surgery. • Inlays have some drawbacks, including possible dry eye, haze, and intolerability. • Better patient selection can help minimize the number of patients who need an inlay removed. • Refractive surgeons are usually adept at managing certain complications caused by inlays. Schematic depiction of the KAMRA inlay optical principle: narrowing the entrance pupil aperture results in a reduction of the defocus blur for near targets and increase depth of focus. “Couple that with individuals working longer and enjoying a full life into their 60s, 70s, and beyond, and this is a need that is real,” Dr. Vukich said. Inlays offer a convenience for patients in the presbyopic age who may want to avoid reading glasses, said Dr. Vukich, who gained experience with inlays early on as part of the original U.S. Food and Drug Administration trial for the KAMRA lens (AcuFocus, Irvine, California). Inlays also provide a gap procedure for patients between the ages of 45 and 60 who may not be ready to assume the risks of an intraocular procedure, said Jay Pepose, MD, PhD , director, Pepose Vision Institute, St. Louis, Missouri, and professor, clinical ophthalmology and visual sciences, Washington University School of Medicine, St. Louis, Missouri. Inlays also can be adjusted if needed, said Damien Gatinel, MD, PhD , Rothschild Foundation, Paris, France. “Adjustability refers to the possibility of recentering the inlay postoperatively and, in some cases, fine tune refraction after inlay implantation with additive corneal surgery,” Dr. Gatinel said. “Inlays are usually implanted in one eye, but optimal refraction for distance vision of the contralateral eye may sometimes require a bilateral refractive procedure,” he said. Reversibility as an advantage Another advantage is that inlays are reversible in a way that LASIK is not, said Robert Maloney, MD , Maloney Vision Institute, Los Angeles, California. “Generally, if the patient is unhappy 3 months after inlay insertion, more time won’t make him or her happy. That is a good time to remove the inlay,” he said. An inlay should be removed if both local medical and surgical adjunct postoperative therapies do not provide the patient with satisfactory results, Dr. Gatinel said. “Local complications such continued on page 17