Eyeworld

I N FOCUS 50 | EYEWORLD | DECEMBER 2019 EXAMINING PRESBYOPIA TREATMENTS "In my practice, we want to be identified as a presbyopia-treating practice—we already are for lens implants, but we want people who are younger than cataract age to come to us," Dr. Hovanesian said. "Think about it from the strategic standpoint. You want patients in their pre-cataract years to come to you for visual solutions so that they stay with you when they need cataract surgery." Dr. Alió and Dr. Vargas continue to see a role for the drops even in patients who have already had cataract surgery. "They are a good option for young presbyopes, patients with previous PresbyLASIK or monovision who are not satisfied with their near vision, or they can also be used in patients who had already been implanted with a monofocal IOL and wish to improve their near vision," they wrote. "The drops have the advantage of being noninvasive, reversible, and with few side effects, distance vision remains stable after their use, which is an advantage over PresbyLASIK and LASIK monovision, and there is no need for neuroad- aptation unlike multifocal IOL implantation." In any case, Dr. Hovanesian said, "we should be open to these. Let's be open to these kind of treatments and see how they work." that we don't really have a good surgical option for the emmetropic presbyope," Dr. Hovane- sian said. The drops may fill that niche—at least until the patient develops a cataract and needs surgery anyway. Certainly, Dr. Vejarano sees these drops as occupying a space in practice entirely their own. Ultimately, Dr. Hovanesian sees these drops as working synergistically with other treatment modalities. He expects that people who devel- op the need for reading glasses "will gravitate toward these drops as they become available, as a way to sort of test the waters." "I think a fairly large number of people are going to enjoy the benefits of the drops, but probably not like either the side effects of the drops or just their need to continue tak- ing them, and then they'll probably gravitate towards surgery," he said. Furthermore, the drops can also be used in preparation for other interventions, such as monovision. Rather than using a contact lens to test a patient's receptivity to monovision, instead they could try pharmacological mono- vision. In that sense, Dr. Hovanesian said, the drops will "propel surgery forward." continued from page 49 Reference 1. Vargas V, et al. Near vision im- provement with the use of a new topical compound for presbyopia correction: A prospective, consec- utive interventional non-compar- ative clinical study. Ophthalmol Ther. 2019 March;8(1):31–39. Relevant financial interests Alió: None Hovanesian: Refocus Group, Novartis, Allergan Korenfeld: Encore Vision, Novartis, Allergan, Orasis Vargas: None Vejarano: None •Phaco Fundamentals: Principles and Pearls for Optimizing Phaco Machine Settings for Different Cataracts •Advancing Glaucoma Medical Therapies, Making MIGS Treatment Decisions, and Combining Procedures in the Context of Cataract Surgery •Lens-Based Astigmatism Correction: Pearls for Success with Toric IOLs •Improving the Cataract Patient Experience: Minimizing Pain and Inflammation while Reducing the Need for Topical Drops •New Approaches to the Diagnosis and Management of Important Corneal Disorders in the Cataract and Refractive Patient •50 Shades of Subconjunctival MIGS: Interventional Glaucoma, The Who, What, Why, and How •Optimizing the Ocular Surface and Meibomian Glands in the Surgical Setting: From Algorithm to Treatment Visit purchase.ascrs.org for more information Don't miss your chance to claim free CME credit. The following CME activities expire on February 29, 2020: Contact information Alió: jlalio@vissum.com Hovanesian: jhovanesian@harvardeye.com Korenfeld: michaelskorenfeld@gmail.com Vargas: draverovargasfragoso@gmail. com Vejarano: felipev@fov.com.com

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