Eyeworld

R Contact information Name: by Title MAY 2019 | EYEWORLD | 37 present two cases where KAMRA was used in patients with bilateral multifocal IOLs who were dissatisfied with their near vision or complained of photic phenomenon. Generally, the approach to such patients is to methodically correct any residual refractive error, assess the lens capsule and treat even small amounts of PCO, aggressively treat dry eye, evaluate the macula for conditions that can reduce contrast, and finally allow adequate time for neuroadaptation. In Cases 2 and 3, Dr. Fox and colleagues took another approach. The residual refractive error was left uncorrect- ed in the dominant eye and a KAMRA inlay was implanted in the nondominant eye, in one case associated with simul- taneous PRK with a –0.75 D target and in the other leav- ing the eye with –0.62 D spherical equivalent. Optically, this combination of a KAMRA small aperture inlay in an eye with a multifocal IOL with the eye targeted for –0.75 D improves near vision but at the cost of decreased uncor- rected distant vision. In addition, if the scotopic pupil size is larger than the inlay (which is likely), this would decrease the quality of the distance image. The combination of loss of illumination from the inlay would be compounded with the loss of light to higher diffractive orders with the mul- tifocal IOL, potentially reducing contrast sensitivity. It also does not address photic phenomenon in the dominant eye with the multifocal, which would persist. On the upside, if the patient was disturbed by the outcome of the KAMRA in this setting, the inlay could be easily removed. Perhaps the effect could be (in part) tested preoperatively by a trial of low-concentration pilocarpine drops. 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. We find the rationale for use in monofocal IOL patients sound and straightforward (with the inlay having been implanted first and the patient undergoing cataract surgery with a monofocal IOL 5, 6 targeted at –0.75 D, placing the inlay following monofocal implantation and assuring the end refraction is in this zone, or by implanting an IC-8 with the same target). However, use of the inlay as a primary treatment for dissatisfied patients with multifocal IOLs may have more potential downsides than with a monofocal IOL, and we suggest first treating the residual refractive error (even by a trial of contact lenses or spectacles) and systematically going down the aforementioned checklist of conditions that can reduce contrast sensitivity and increase glare and photic phenome- non before considering a KAMRA inlay in this setting. Look to Stephens for anterior and posterior micro-instruments. I N S T R U M E N T S | S I N G L E U S E | D R Y E Y E | B I O L O G I C S Stephens Instruments | 2500 Sandersville Rd | Lexington KY 40511 USA Toll Free ( USA ) 800.354.7848 | info@stephensinst.com | stephensinst.com © 2019 Stephens Instruments. All rights reserved. Microsure Instruments are an excellent choice for anterior and posterior microsurgery. Available with 23ga and 25ga stainless steel tips and lightweight titanium grips, they offer the precision and durability needed for delicate procedures. All of our instruments are backed by a limited lifetime warranty. You can feel confident in the high quality and superior service that Stephens is known for. Stephens – more than instruments. 23GA & 25GA NOW AVAILABLE ST5-7035 Utrata Capsulorhexis ST5-7000 Straight Serrated Jaws ST7-1715 Curved Scissors

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