EyeWorld India June 2017 Issue

June 2017 18 EWAP FEATURE Raindrop flap up with inlay and dimensions Source (all): ReVision Optics Choosing a corneal inlay candidate by Stefanie Petrou Binder, MD EyeWorld Contributing Writer Experts reveal the right and the wrong patient criteria for corneal inlay implantation C orneal inlays are a new option for correcting presbyopia and a hot topic. These intrastromal devices are additive, meaning they achieve the desired refraction without the removal of any corneal tissue. Choosing the right candidate for corneal inlays will determine the success of the procedure and ultimately the recipient’s satisfaction. EyeWorld spoke with two leading corneal inlay advocates about their decision-making process. Contact lens test It is best if patients get a feel for what vision will be like with AT A GLANCE • Use of the contact lens test offers a realistic simulation of distance vision but is not always representative of near vision. • The contact lens test assumes an important role in determining corneal correction of presbyopia, especially in perfectionist patients. • A pristine distance correction in the dominant eye is of key importance. • Many of today’s patients had their distance vision corrected when they were younger and now desire near vision correction. Raindrop inlay in the cornea corneal inlays before taking the dive. A good way to do this is with a contact lens test, which is designed to simulate the desired refraction. It can be a useful tool in refining a patient’s visual needs and tolerance, according to Lance Kugler, MD , Truhlsen Eye Institute, University of Nebraska Medical Center, and Kugler Vision, Omaha, Nebraska. In an interview with EyeWorld, Dr. Kugler explained, “I think there is a role for the contact lens trial in the evaluation of corneal inlay patients, but I think we need to be careful. The multifocal contact lens test seems to offer a reasonable simulation of what distance vision is like once the inlays are in. But the contact lens test is not always as representative for near vision results. If a patient likes his vision with the multifocal contact lens, he is probably going to like his vision with the Raindrop inlay [ReVision Optics, Lake Forest, California]. But even if he doesn’t like what vision is like with the contact lens trial, there is still about a 50% chance he’ll like vision with the Raindrop, according to a recent trial.” Dr. Kugler thinks that experienced refractive surgery practices are adept at evaluating individuals who can tolerate monovision or one-eye dominance for distance, and although most will try a contact lens trial, eye doctors won’t solely rely on contact lens testing. It is a useful guideline, especially for physicians who are new to corneal inlays and monovision for individuals with dysfunctional lens syndrome (DLS) treatment, however, he feels that the test has a relatively low specificity and that surgeons need to take that into consideration. According to Vance Thompson, MD , Sanford University of South Dakota School of Medicine, and Vance Thompson Vision, Sioux Falls, South Dakota, the contact lens test is revealing in a few important ways. “We know that monovision creates the most blur at a distance, and if an individual can tolerate that blur, there is a high likelihood