EyeWorld Asia-Pacific September 2019 Issue

58 EWAP SEPTEMBER 2019 REFRACTIVE 20/20 or better in each eye, and > `ˆvviÀi˜Vi œv ćä°xä LiÌÜii˜ manifest refraction spherical equivalent and cycloplegic refraction spherical equivalent. Visual acuity improvements were most pronounced when subjects employed bilateral vision, with 84% achieving 20/40 bilateral vision or better versus 52% in the placebo group. Fifty-three percent of the study «>À̈Vˆ«>˜Ìà >V…ˆiÛi` > Ĉä°Ó logMAR change in the bilateral vision versus 22% in placebo. “EV06 was safe and well- tolerated,” Dr. Korenfeld said. “No subjects discontinued, and there were no sight threatening AEs or changes in IOP. The drug was comfortable upon installation and caused no change in best corrected distance visual acuity, manifest refraction spherical equivalent, cycloplegic refraction, or in pupil diameter.” Persistent drug effect An observational follow-up assessment on the long-term effects of bilaterally dosed topical lipoic acid choline ester eye drops demonstrated some interesting results. The drug effects on near visual improvement persisted in the study group long after dosing with EV06 was stopped at day 91. Dr. Korenfeld reported È}˜ˆwV>˜Ì ivviVÌà Vœ“«>Ài` ̜ KAMRA small aperture inlay in an eye with a multifocal IOL with the eye targeted for –0.75 D improves near vision but at the cost of decreased uncorrected distant vision. In addition, if the scotopic pupil size is larger than the inlay (which is likely), this would decrease the quality of the distance image. The combination of loss of illumination from the inlay would be compounded with the loss of light to higher diffractive orders with the multifocal IOL, potentially reducing contrast sensitivity. It also does not address photic phenomenon in the dominant eye with the multifocal, which would persist. On the upside, if the patient was disturbed by the outcome of Pearls, pitfalls - from page 53 placebo 241 days after the end of the study period, with only a small amount of treatment degradation. “Seven months after the end of the 3-month study time, 39% of the subjects treated “>ˆ˜Ì>ˆ˜i` > Ĉä°Ó œ} Ƃ, change in bilateral near vision, compared to only 6% in placebo. More trials using EV06 are being planned for 2019,” he said. According to Dr. Korenfeld, 6äÈ Ü>à wÀÃÌ `iÛiœ«i` L>Ãi` on the hypothesis that the oxidation of lens proteins was at least partially responsible for lens stiffness in presbyopia and that it might be reversed chemically. “It made sense from a theoretical standpoint. Then it was demonstrated in vitro. Now the hypothesis is being supported by data collected in an active treatment setting, in terms œv ۈÃÕ> œÕÌVœ“iÃ] È}˜ˆwV>˜Ì safety issues, and adverse events. It is plausible that the effect of lipoic acid on ‘softening’ lens proteins could open up further treatment options with the drug. It is conceivable that the early, pre-cataract application of topical EV06 could potentially be used to delay or prevent nuclear sclerotic cataract,” he said. EWAP Editors’ note: Dr. Korenfeld practices at the Department of Ophthalmology and 8KUWCN 5EKGPEGU 9CUJKPIVQP 7PKXGTUKV[ 5V .QWKU CPF JCU ƂPCPEKCN KPVGTGUVU KP Novartis. the KAMRA in this setting, the inlay could be easily removed. Perhaps the effect could be (in part) tested preoperatively by a trial of low-concentration pilocarpine drops. Advances in ophthalmology are made by insightful, talented surgeons trying new things, and we applaud Dr. Fox and colleagues both for pioneering work and for sharing their experience with the off-label use of the KAMRA inlay in «ÃiÕ`œ«…>Žið 7i w˜` ̅i rationale for use in monofocal IOL patients sound and straightforward (with the inlay …>ۈ˜} Lii˜ ˆ“«>˜Ìi` wÀÃÌ >˜` the patient undergoing cataract surgery with a monofocal IOL 5,6 targeted at –0.75 D, placing the inlay following monofocal implantation and assuring the end refraction is in this zone, or by implanting an IC-8 with the same target). However, use of the inlay as a primary treatment vœÀ `ˆÃÃ>̈Ãwi` «>̈i˜Ìà ܈̅ multifocal IOLs may have more potential downsides than with a monofocal IOL, and we ÃÕ}}iÃÌ wÀÃÌ ÌÀi>̈˜} ̅i ÀiÈ`Õ> refractive error (even by a trial of contact lenses or spectacles) and systematically going down the aforementioned checklist of conditions that can reduce contrast sensitivity and increase glare and photic phenomenon before considering a KAMRA inlay in this setting. EWAP Editors’ note: Dr. Pepose is director CPF HQWPFGT 2GRQUG 8KUKQP +PUVKVWVG CPF RTQHGUUQT QH ENKPKECN QRJVJCNOQNQI[ 9CUJKPIVQP 7PKXGTUKV[ 5EJQQN QH /GFKEKPG 5V .QWKU CPF JCU ƂPCPEKCN KPVGTGUVU KP #EW(QEWU CPF $CWUEJ Lomb. Dr. Ang and Dr. Remo practice CV VJG #UKCP '[G +PUVKVWVG /CMCVK %KV[ 2JKNKRRKPGU &T #PI JCU ƂPCPEKCN KPVGTGUVU KP #EW(QEWU CPF $CWUEJ .QOD &T 4GOQ JCU PQ TGNGXCPV ƂPCPEKCN interests. References 1. Vukich JA, et al. Evaluation of the small-aperture intracorneal inlay: Three-year results from the cohort of the U.S. Food and Drug Administration clinical trial. J Cataract Refract Surg . 2018;44:541–556. 2. Dick HB, et al. Prospective multicenter trial of a small-aperture intraocular lens in cataract surgery. J Cataract Refract Surg . 2017;43:956–968. 3. Linn SH, et al. Stereoacuity after small aperture corneal inlay implantation. Clin Ophthalmol . 2017;11:233–235. 4. Elling M, et al. Implantation of a corneal inlay in pseudophakic eyes: A prospective comparative clinical trial. J Refract Surg . 2018;34:746–750. 5. Tan TE, Mehta JS. Cataract surgery following KAMRA presbyopic implant. Clin Ophthalmol . 2013;7:1899–903. 6. Moshirfar M, et al. Cataract surgery in patients with a previous history of KAMRA inlay implantation: A case series. Ophthalmol Ther . 2017;6:207–213