EyeWorld India March 2016 Issue

50 EWAP refractive March 2016 Laser or inlay? Helping patients with a new decision by Rich Daly EyeWorld Senior Contributing Writer Careful preop screening and education as well as some adjunctive treatment should precede inlay use T he first step in assessing a presbyopia treatment is for surgeons to ensure they are properly selecting a corneal-based procedure over a lens-based procedure. One of the favorite techniques of Vance Thompson , MD , professor of ophthalmology, Sanford School of Medicine, Sioux Falls, SD, for checking whether patients’ lenses are clean is to ask about their nighttime image quality. He also measures the optical or objective scatter index (OSI) with the HD Analyzer (Visiometrics, Terrassa, Spain) to check the forward scatter or how light is affected as it travels through the cornea and lens. Dr. Thompson uses the Pentacam (Oculus, Arlington, Wash.) to measure the lens density. After those steps, Dr. Thompson uses an objective diagnostic test, the iTrace (Tracey Technologies, Houston) to further ensure lens clarity. Then Dr. Thompson discusses with patients why he only treats one eye. “It is an exercise in compromise when you are going to do a corneal correction of presbyopia,” Dr. Thompson said. “I want them to understand that even if we get their reading eye doing well, sometimes in the distance eye the near blur can affect the near image quality.” In patients sensitive to those issues, a contact lens test is conducted with a plus 1.25 D lens contact—typically in the non- dominant eye, which is the best choice for reading in about 80% of patients. There are some who prefer their dominant eye as their reading eye. “If they say, ‘I love the vision from that contact, and I love the contact’ then I say, ‘Wear the contact,’” Dr. Thompson said. “If they say, ‘I love the vision but I don’t love the contact’ I tell them about refractive surgery. And monovision is still a great option. They just need to understand it blurs distance more than inlay vision.” Gregory D. Parkhurst, MD, physician CEO, Parkhurst-NuVision, San Antonio, and adjunct assistant professor, Rosenberg School of Optometry, University of the Incarnate Word, San Antonio, uses a customized approach that gives patients a chance to see their options preop through a simulation. For presbyopic patients, that means using a blended vision trial, which is a simulation of what can be accomplished with monovision LASIK versus introducing multifocal optics into their system. “We’ll display a couple of different powers of monovision in the non-dominant eye via a contact, and we also show them multifocal optics with a multifocal lens simulator,” Dr. Parkhurst said. “Usually after seeing that the patients will guide us.” Dr. Parkhurst will either perform LASIK surgery or consider inlays or multifocal IOLs for patients who like multifocal optics. Instead of performing a trial to see if the patient accepts monovision, Stanley B. Teplick , MD , medical director, Teplick Custom Vision, and adjunct professor of ophthalmology, Pacific University College of Optometry, Beaverton, Ore., shows patients— through a pinhole demonstration— their potential near vision gains from an inlay. When inlays are preferred In patients who don’t want to blur distance much, corneal inlays can sometimes provide the near image in that one eye, and patients often maintain 20/20 or The KAMRA corneal inlay Source: AcuFocus