Eyeworld

APRIL 2022 | EYEWORLD | 79 R can be a little more aggressive with younger patients," he said. Dr. Wiley has also found a benefit to SMILE vs. LASIK in that it leaves more future advance- ment options open for the patient. If you do LASIK in a 30-year-old, and 30 years later they need an IOL, if you need to enhance after the IOL surgery, your only option is PRK, he said. You can't easily lift the flap; there is a risk of epithelial ingrowth or scarring. He also said PRK after LASIK is not quite as predictable. "What's nice with SMILE is you have the ability to con- vert SMILE to LASIK years or decades after," he said. This leaves the potential to have a LASIK flap created in the future after an IOL and thus have a more predictable adjustment procedure if the need arises. The future of implants In the time since he completed ophthalmology training, Dr. Rebenitsch said that he's found it exciting the way the conversation with the patient has changed. It has become less of a question of if a patient is a candidate for an ad- vanced technology IOL and has shifted to what type of advanced technology IOL is an option for them. With the advent of extended depth of focus lenses, the LAL, and potentially with better accommodating lenses in the future, Dr. Rebenitsch said that every patient should qualify for something. One of the things he's most excited for is the IC-8 (AcuFocus). "Our practice placed more than 250 KAMRA inlays with a 95% satisfac- tion rate," he said, adding that he thinks this pinhole technology is better in the sulcus or in an IOL. "For patients with aberrated corneas who have historically not qualified for anything, they now will have something that will manage astigmatism, give extended depth of focus, and give overall higher satisfaction and spectacle independence than we could have done in years past," he said. Dr. Rebenitsch also spoke about other tech- nology that he's looking forward to implement- ing, specifically those for presbyopia. He men- tioned drops for presbyopia and the approval of VUITY (pilocarpine HCl ophthalmic solution, Allergan), the first of these products, noting that it will "act as a bridge" for many patients. "What I'm really looking forward to is there should be an extended depth of focus ICL in the future," Dr. Rebenitsch said. Presbyopic high myopes don't have a lot of good options cur- rently, he added, and an extended depth of fo- cus ICL could create a bridge for these patients until they want to have cataract surgery. Even for patients who have had dated corneal refractive surgery, Dr. Wiley said some newer technologies in the works could be useful, including the IC-8. A small aperture IOL is a great option for patients with previous RK, he said, especially because current technology doesn't do a good job of giving multifocality or EDOF to these patients. Dr. Wiley also mentioned other technolo- gy on the horizon, like the Gemini Refractive Capsule (Omega Ophthalmics), which he said is designed to go into the capsular bag to hold it open to allow for lens exchangeability. He also noted the option of phakic IOLs, particularly the EVO (STAAR Surgical). It allows for a non-corneal altering procedure and keeps all options open for the long term, Dr. Wiley said. "As implantable contact lens technology evolves and doctors become more comfortable with that, we'll see wider use for even medium to moderate prescriptions, we'll see alternatives going forward for phakic IOLs, which are less invasive to the eye, and we'll see that those truly do keep the broadest options open for the patient," he said. Dr. Wiley also mentioned the use of pres- byopia drops in the future as more experience is gained with VUITY and as similar products are brought to market. It gives us some ability to consider that presbyopia myope who wants distance vision or monovision, he said. "With presbyopic drops, it gives more options for spec- tacle independence," Dr. Wiley said. These options could give some longevity to corneal refractive surgery, Dr. Wiley said. "In the past, once a patient had corneal refractive sur- gery then lens surgery, it was so permanent that you had to be so careful about what lens you chose because they would be married to it for their lifetime." Now, Dr. Wiley said there is the understanding that there are some exchange- able options on the horizon. Relevant disclosures Lee: AcuFocus Rebenitsch: Carl Zeiss Meditec, STAAR Surgical Wiley: Alcon, Allergan, Bausch + Lomb, Carl Zeiss Meditec, Johnson & Johnson Vision, Omega Ophthalmics, RxSight, STAAR Surgical Contact Lee: bryan@bryanlee.pro Rebenitsch: Dr.Luke@ClearSight.com Wiley: wiley@cle2020.com

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