EyeWorld Asia-Pacific June 2017 Issue

EWAP FEATURE 21 June 2017 View of posterior subcapsular cataract showing how it interferes with patient vision Source (all): Kevin Waltz, MD Roles vary for inlays among presbyopia treatments by Rich Daly EyeWorld Contributing Writer Surgeons’ experience with corneal inlays have shown which patients can benefit and how the devices interact with other treatments T he emerging presbyopia treatment of corneal inlays expands surgeons’ options, but the technology can affect other vision treatments. Corneal inlays are one of a growing number of surgical options to address the deteriorating function of the crystalline lens over time, known as dysfunctional lens syndrome (DLS). LASIK monovision is the traditional treatment for many patients with stage 1 DLS, which for many patients is not only presbyopia but an uncoupling of the offset of spherical aberration between their lens and cornea. Jay Pepose, MD, PhD , director, Pepose Vision Institute, and professor of clinical ophthalmology, Washington University School of Medicine, St. Louis, Missouri, AT A GLANCE • More myopic patients tend to do well with a KAMRA inlay. • Low hyperopes tend to be set up better for a Raindrop. • Monovision contact lenses can simulate either available corneal inlay. • Cataract surgery can be performed with an inlay in position. • Corneal inlay performance may improve following natural lens replacement. Side view of an inlay as a diamond blade corneal incision is created Microscope view of KAMRA inlay in an eye with a posterior subcapsular cataract Cataract removed with phaco under the inlay considers LASIK with blended vision for suitable candidates after assessing corneal topography, pachymetry, and the ocular surface. Stage 1 patients also can now be treated with the KAMRA inlay (AcuFocus, Irvine, California), which is a small aperture implant placed in a lamellar pocket. The device works best implanted monocularly in –0.75 D eyes, whether with natural vision or after LASIK, Dr. Pepose said. In comparison, the Raindrop inlay (ReVision Optics, Lake Forest, California), which is placed directly under a LASIK-type flap, can help patients with good distance vision and up to 1 D of hyperopia. Among stage 1 patients considering corneal inlays, William Wiley, MD , medical director, Cleveland Eye Clinic, Cleveland, Ohio, may try a multifocal or monovision contact lens, which provides similar optics to a Raindrop inlay. “That simulates nicely what Raindrop vision is,” Dr. Wiley said. “Alternatively, we can demonstrate an aperture optic with a pinhole occluder in the office to simulate the optics of a KAMRA corneal inlay.” Dr. Wiley discusses advantages and disadvantages of each option for patients, some of which depends on their baseline prescription. More myopic patients—in the range of –0.5 D or –0.75 D—tend to do well with a KAMRA inlay, Dr. Wiley said. “It seems that the KAMRA with aperture vision optics, takes good intermediate vision and extends the depth of focus to both distance and near,” Dr. Wiley said. “So patients starting with mild myopia do well with the KAMRA inlay.” If the patient is a low hyperope, he or she tends to set up better for a Raindrop. The “sweet spot” is somewhere between +0.5 D and +0.75 D, Dr. Wiley said. The inlay continued on page 23