Eyeworld

MAY 2019 | EYEWORLD | 35 R POINT/COUNTERPOINT Contact information Pepose: jpepose@peposevision.com Ang: rtang@asianeyeinstitute.com Remo: jmremo@asianeyeinstitute.com by Jay Pepose, MD, PhD, Robert Ang, MD, and Jocelyn Remo, MD AcuFocus), and the patient is targeted for –0.75 D in the small aperture eye. Another advantage of this approach is enhanced stereopsis with the inlay in place compared to in patients with a comparable amount of monovision without the inlay 3 . In further support of this concept, a pro- spective, randomized, clinical trial was conduct- ed of the KAMRA inlay in the nondominant eye of patients undergoing phacoemulsification with bilateral monofocal IOLs. In this trial, the inlay was implanted in the nondominant eye in a premade 200 µm femtosecond laser-assisted corneal pocket immediately after phacoemulsifi- cation and implantation of a three-piece Tecnis monofocal IOL (Johnson & Johnson Vision), with the same monofocal IOL also placed in T he KAMRA inlay (CorneaGen) is a thin, carbon-impregnated polyvi- nylidene corneal inlay with a 1.6 mm central aperture and 3.8 mm outer diameter placed in a deep femtosec- ond-laser assisted corneal stromal pocket to provide extended depth of focus by blocking unfocused peripheral rays of light via small aperture optics. While the inlay is not approved for use in pseudophakes, sur- geons can and have used new medical devices off-label when there is good medical rationale and an exercise of sound medical judgment in the best interest of the patient. We are grateful to Drs. Fox, Augustine, and Wiley for sharing their experience with the off-label use of the KAMRA inlay in pseudophakes. Dr. Fox and colleagues used the KAMRA inlay in two clinical different settings: (1) in patients bilaterally implanted with monofocal IOLs and (2) in patients implanted with multi- focal IOLs. In patients with monofocal IOLs, by targeting –0.75 D in the nondominant eye, this shifts the flat defocus curve produced by the KAMRA inlay to the right, expanding through focus with minimal impact on distant vision. This is supported by the findings in Case 3 of Dr. Fox et al.'s article in a patient with pseudophakic mini-monovision, where the UCDVA in the nondominant eye improved from 20/40 to 20/20-2 and the near improved from borderline J3 to J1+ following KAMRA implantation. These findings are very similar to what has been reported when the inlay has been used in phakic patients 1 and also when the small aperture is integrated into an IOL 2 (IC-8 IOL, Pearls, pitfalls of small aperture inlay for unhappy pseudophakic patients About the doctors Jay Pepose, MD, PhD Director and founder Pepose Vision Institute Professor of clinical ophthalmology Washington University School of Medicine St. Louis Robert Ang, MD Asian Eye Institute Makati City, Philippines Jocelyn Remo, MD Asian Eye Institute Makati City, Philippines continued on page 36 vision issues at both distance and near were able to have their concerns addressed with a KAM- RA corneal inlay. These cases highlight the potential of future applications for the KAM- RA inlay, specifically as a therapeutic tool in the treatment of suboptimal vision quality in other clinical scenarios. In the case of past cataract surgery with a monofocal implant, the KAMRA inlay with its mechanism of small aperture optics appears to be a good solution for the restoration of uncorrected reading acuity with improvement of uncorrected distance acuity. continued from page 34 "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 pseudophakes."

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