FEATURE 20 EWAP MARCH 2022 multifocal lenses have achieved such a great level of quality that he typically opts for an RLE rather than an inlay. Shehzad Batliwala, DO, shared some thoughts on the case. He said he thinks it’s important to note how this case demonstrates the advancement of modern LASIK in terms of the lasers and ablation profiles used to minimize optical aberrations. “We were still able to put a multifocal lens in this patient after having had hyperopic LASIK, which, 10–15 years ago, was unheard of,” Dr. Batliwala said. “As excimer lasers have improved their optics, this has allowed us to continue to use multifocal lenses in these types of patients.” EWAP Editorso note Dr. $atliwala is a surgery fellow at ClearSight LASI- Vision, Oklahoma City, Oklahoma, and declared no relevant financial interests. Dr. ReDenitsch is Medical Director, ClearSight LASI- Vision, Oklahoma City, Oklahoma, and has interests with Carl <eiss Meditec, Legrande, OSR: Pharmaceuticals, and S6AAR Surgical. said, so he discussed with the patient the option of doing a multifocal lens in the dominant eye and a monofocal lens behind the existing KAMRA. “He understood that there was an increased risk of halo and glare, but he wanted to have distance and near in both eyes,” Dr. Rebenitsch said. Dr. Rebenitsch used a TECNIS ZKB00 (Johnson & Johnson Vision) +2.75 add in the right eye and a ZCB00 single focus lens in the left eye. At his 1-day postoperative exam, the patient was ecstatic. At 1 month after surgery, Dr. Rebenitsch said the patient still noticed some minor light sensitivity and foggy vision but now has vision better than he had with the KAMRA inlay initially. Dr. Rebenitsch shared several takeaways from this case. First, it’s expected that patients will drift hyperopic. Even though the KAMRA inlay target is between –0.75 and –1.0 D, you will lose some of that depth of focus as people naturally drift more hyperopic and become more presbyopic. Dr. Rebenitsch said this case highlights the fact that in some instances, multifocal lenses can be a great option in post-hyperopic LASIK patients. The surgeon must ensure that the cornea is pristine with acceptable spherical aberration and minimal higher order aberrations. A well-centered ablation is critical. Dr. Rebenitsch noted that many surgeons have stopped using inlays. Because of the natural hyperopic drift over time, some patients are coming back several years after their inlay procedures and are looking for a more permanent solution, he explained. Additionally, Dr. Rebenitsch said that he thinks 5cheiOpƃWI Xiew oH the -#/4# inNay showinI that it is in deep cornea aDoWt Oicrons away HroO the endotheNiWO which OiniOi\es inƃaOOation indWced ha\e dWe to a Nower concentration oH Meratocytes. Topography of both eyes of a patient at lens replacement evaluation; right eye topoIraphy shows that eXen in the settinI oH post hyperopic .#5+- the sphericaN aDerration and oXeraNN aDNation profiNe is condWciXe to haXinI a OWNtiHocaN pNaced in the eye; the left eye topography is in the presence of the KAMRA inlay. Source (all): Shehzad Batliwala, DO, and Luke Rebenitsch, MD
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