EyeWorld India June 2017 Issue

June 2017 12 EWAP FEATURE What’s available now and what’s coming down the pipeline with these presbyopia-correcting implants “ I ntracorneal inlays have come a long way since they were first introduced as a concept in 1949 by Jose Barraquer, MD, Barcelona, Spain. 1 In the decades following, research was conducted on the effect of an implant in the cornea for correction of myopia and aphakia. 2,3 New procedures would eventually supersede inlays for these refractive conditions, but the implants found their market and materials would improve to the point of being well-tolerated within the cornea. Richard Lindstrom, MD , Minnesota Eye Consultants, Minneapolis, Minnesota, first started working with intracorneal inlays 30 years ago History of inlays, the current market, and what’s yet to come by Liz Hillman EyeWorld Staff Writer AT A GLANCE • Intracorneal inlays have a history that dates back decades, starting as a concept for other refractive indications before settling on presbyopia. • There are three different types of inlays (two of which have FDA approval) with different optical principles to help presbyopes regain some near vision without reading glasses. • In addition to serving a previously untapped market, physicians say inlays are rejuvenating other refractive surgeries as well. using polysulfone lenses for the correction of high myopia. While the outcomes for treating myopia were quite good, Dr. Lindstrom noted that the material prevented glucose diffusion and resulted in vascularization. “That, however, led us to appreciate that if you’re going to use a non-permeable material, you need to microperforate it. That was great learning,” Dr. Lindstrom said. Following that, Dr. Lindstrom said he worked with a company to develop a hydrogel intracorneal lens for the treatment of myopia and aphakia. While this showed promise at the time, it was usurped by the success of PRK and LASIK with the excimer laser. “Then we transitioned to the idea that an intracorneal lens might be a useful adjunct for presbyopia,” Dr. Lindstrom said. Fast forward to present day. There are two inlays approved by the U.S. Food and Drug Administration (FDA), the KAMRA inlay (AcuFocus, Irvine, California) and the Raindrop Near Vision Inlay (ReVision Optics, Lake Forest, California), and one in clinical trials leading toward FDA approval, the Flexivue Microlens (Presbia, Irvine, California). All three of these inlays have the CE mark. “The first question patients asked eye surgeons 20 years ago was, ‘Can you get rid of my glasses, can you get rid of my contacts?’ And we could say yes when LASIK was approved,” said Ralph Chu, MD , Chu Vision An early generation Presbia-style hydrogel implant placed by Dr. Lindstrom in 1987. The patient is still doing well 30 years later with 20/25 at distance and J2 at near. Source (all): Richard Lindstrom, MD This early generation polysufone implant placed in 1982 by Peter Choyce, MD, England to treat high myopia shows early vascularization. It eventually needed to be explanted. A patient of Dr. Lindstrom’s with an AcuFocus KAMRA inlay placed in 2015. The patient’s vision is 20/25, J1, and stable.