Eyeworld

SEPTEMBER 2021 | EYEWORLD | 57 R With this, concentric rings are created inside the interior of the cornea to steepen the curvature of the small central zone, adding power and increasing depth of focus. Dr. Bafna said the process is intriguing because it's less invasive overall, but he noted compromises, like loss of Another inlay is the Flexivue Microlens (Presbia), which completed an FDA trial and is being analyzed. Dr. Bafna was involved in this clinical trial. He also mentioned allografts, which use actual corneal tissue instead of a foreign body. These options are still in development or not yet available in the U.S. An inlay from Allotex, which is undergoing FDA trial for near vision, is placed superficially in the cornea with the idea that you want to change the curvature of the non-dominant eye to allow it to focus near. This option is made from human tissue that has been cryopreserved. Soosan Jacob, MD, has introduced a similar idea. Her technique is called the presbyopic allo- genic refractive lenticule (PEARL), which uses leftover corneal lenticular tissue removed in a SMILE procedure. There is a process to make sure there are no issues with the tissue; a small button is taken out and cryopreserved to use in another patient's eye, Dr. Bafna explained. From a corneal perspective, Dr. Waring mentioned the blended vision approach with LASIK and/or PRK and with implantable contact lenses. He also said that there are new scleral treatments in development. He serves as the director of the Scientific Advisory Board for the new Laser Scleral Microporation procedure (LSM, Ace Vision Group), which he said is showing promise in early human trials. This is a minimally invasive presbyopia surgical proce- dure designed to naturally restore function. There are several other surgical procedure options available outside the U.S., Dr. Bafna said, mentioning presbyLASIK, PRESBYOND (Carl Zeiss Meditec), and INTRACOR used inter- nationally. PresbyLASIK creates a multifocal cornea, Dr. Bafna said. "It's an attempt to replace the dynamic process of accommodation with static modification of the corneal surface," he ex- plained, noting that this is primarily for pa- tients who are low hyperopes. It's not used that frequently, he said, due to the loss of contrast sensitivity it creates and reduction in distance vision. With INTRACOR, instead of creating a flap, a femtosecond laser is used to change the overall curvature of the cornea, Dr. Bafna said. continued on page 58 Dr. Waring implants a hybrid diffractive extended depth of focus and multifocal toric IOL during a refractive lens exchange. Source: George Waring IV, MD, FACS

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