EyeWorld Asia-Pacific June 2017 Issue

EWAP FEATURE 17 June 2017 Appasamy Associates Page: 38 www.appasamy.com OCULUS Optikgeräte Page: 46 www.oculus.de Ziemer Page: 72 www.ziemergroup.com World Ophthalmology Congress Page: 59 www.woc2018.org ASCRS Pag e 5, 25 www.ascrs.org APACRS Page 2, 14, 34, 71 www.apacrs.org EyeWorld Page 16, 22, 32 www.eyeworld.org Cornea Society Page 40, 54 www.corneasociety.org Index to Advertisers as inflammation or severe dry eye cause a decrease in vision. In my experience, this may happen in a small percentage of cases and should always be explained to the patient preoperatively,” he said. Surgeons should let patients know that the post-explantation refraction may be slightly different from the preoperative refraction, he added. “The safety record for both the KAMRA and Raindrop [ReVision Optics, Lake Forest, California] inlays were very favorable in preservation of good best-corrected vision in patients where the inlays were removed,” Dr. Pepose said. If exuberant wound healing occurs or a patient has an immune response to an inlay associated with central haze formation around a hydrogel inlay or an amorphous deposit around a small-aperture inlay linked to a hyperopic shift, the patient should be treated with strong steroid therapy, he advised. “If they don’t respond, then early removal of the inlay generally leads to more rapid return of uncorrected and best-corrected vision,” he said. One inlay advantage ophthalmologists may not always consider is its role as a practice builder, Dr. Vukich said. Offering inlays will bring in patients who may not otherwise come to a practice, and even those who are not candidates may be interested in other options to relieve their presbyopic symptoms, he said. Inlays and cataract surgery Surgeons with inlay experience also note that inlays can still function well after cataract surgery. “I have performed some cataract surgeries in patients implanted with the KAMRA, and it did not make the surgery difficult,” Dr. Gatinel said. “The target refraction should be planned to be slightly myopic (–0.75 D) for small-aperture inlays.” Dr. Vukich has seen patients with inlays who go on to receive a monofocal IOL and retain a near visual acuity benefit. The inlays also have not hampered the ability to perform cataract surgery. “The ability to enjoy the near benefit and maintain that through the years in which cataract development is likely and after cataract surgery, maintain that ability is another distinct advantage,” he said. Potential drawbacks As with any surgical procedure, inlays come with certain risks, including corneal haze, glare, and a drop in best-corrected visual acuity, Dr. Maloney said. However, the haze does not seem to have much effect on vision, he added. “There’s no such thing as a surgery with a zero complication rate. We know that individuals with significant dryness in their eyes can have a diminished effect,” Dr. Vukich said. Inlays also require some extra preoperative planning and follow- up, Dr. Gatinel said. For instance, surgeons and their staff may spend extra time explaining to patients what inlays are, as some are reluctant to have what they think will be a “foreign body” in their eyes. “Some patients think of it as a relatively bulky or electronic device, and it’s important to dissipate such misconceptions,” he said. Sometimes, patients have a hard time tolerating inlays, and that can be another drawback, Dr. Gatinel said. This could be linked with interferences with corneal metabolism and dry eye-induced symptoms. Suboptimal results usually trace back to inappropriate patient selection, Dr. Gatinel said. “Low myopes should be regarded with caution, as no multifocal or extended depth of focus correction method can provide the crisp vision that these patients have without their distance correction,” he said. Inlays also do not stop the onset of progressive lenticular dysfunction and opacity, Dr. Pepose said. “Small-aperture inlays may be more immune to the effects of progressive presbyopia, as their mechanism of action involves blocking unfocused peripheral light rather than the induction of dioptric change or negative spherical aberration,” he said. Although there is a risk for damage that occurs after flap creation—something needed for inlay insertion—those risks and the ways to fix them are familiar to refractive surgeons, Dr. Vukich said. “We are very comfortable with the techniques so these problems are unusual and when they do occur, we can handle them,” he said. EWAP Editors’ note: Dr. Vukich has financial interests with AcuFocus. Dr. Pepose has financial interests with AcuFocus and Abbott Medical Optics (Abbott Park, Illinois). Drs. Gatinel and Maloney have no financial interests related to their comments in this article. Contact information Gatinel: gatintel@gmail.com Maloney: rm@maloneyvision.com Pepose: jpepose@peposevision.com Vukich: javukich@gmail.com Weighing – from page 15