Eyeworld

EW FEATURE 41 Kevin L. Waltz, M.D., Eye Surgeons of Indiana, Indianapolis, reported on 407 patients with follow-up through month 6. In the non-domi- nant eye, 17.9% achieved 20/20 un- corrected near vision, 67.3% were at 20/32, and 83% were 20/40; 93.4% were 20/32 in distance vision, and 97.1% achieved 20/40 or better dis- tance vision. The Snellen distance vision improves over time, he said, but remains "essentially un- changed." Dr. Thompson said in his arm of the U.S. study, "there was a slight reduction in contrast sensitiv- ity in the inlay eye; these patients read quite well with their reading eye and their distance vision in that same eye was still often 20/20 … it is a different 20/20, but still quite a bit more comfortable than the distance blur created with monovision laser to achieve the same near function- ing." He said patients reported a high rate of satisfaction. With results out to 36 months, Dr. Grabner said 90% had J3 or better and none had a loss of distance vision. "The inlay had to be centered for good near vision," he told EyeWorld. "It's not as important for distance vision. In our earlier stud- ies, we did not realize centration was so important." Dr. Pallikaris's latest study in- cludes the femtosecond laser for flap creation; the current study evaluated 20 patients. "After surgery, uncorrected near visual acuity was 20/25 or better in 77%," he said. "A full 92% did not use reading glasses and 8% used reading glasses for less than half of their near activities." Of those with 15 months follow-up, 77% were 20/16 in near vision, he said. He added that the implanted eye tended to show a slight decrease in distance vision. An earlier study using the mi- crokeratome has results out to 3 years, Dr. Pallikaris said. Results with the femtosecond are "very similar" to those with the microkeratome. There have been no adverse events reported that have affected the inlay's performance, he said. In the original cohort, presbyopia pro- gressed in two patients, and the in- lays had to be replaced. During the early learning curve, "there were some patients who had epithelial in- growth because we had mistakenly put some cells in the tunnel," he said. Initial data presented on the Vue+ seems encouraging as well, with subjects averaging five-line im- provements in near vision with no more than two lines lost in distance vision. At 3 months (N=30), all sub- jects achieved 20/25 uncorrected near vision and 20/20 distance vi- sion binocularly. All implanted eyes were 20/40 or better. At the 2010 ASCRS Annual Meeting, Enrique Barragan presented on the PresbyLens (the previous name for the Vue+). At 6 months (n=34), the mean uncorrected near vision in the implanted eye was J1, 20/25, which corresponded to a four-line improve- ment. Intermediate vision improved by a mean of two lines, and distance vision decreased by a mean of one and a half lines. Binocularly, how- ever, no patient was worse than 20/25. Although biocompatibility seemed to be an issue in the earliest studies dating back to the 1960s, Dr. Pallikaris says that's no longer an issue. February 2011 June 2011 PRESBYOPIA An example of the Kamra implanted and recentered after 7 months Source: Günther Grabner, M.D. The Kamra corneal inlay Source: AcuFocus Corneal continued from page 38 Surgeons should first test the patient's level of expectation with a simulation of the effect of INTRA- COR by adding a contact lens to the patient's eye with myopia to mimic the myopic shift that the patient might have later on, Dr. Holzer said. "We ask [the patient], 'Will you be satisfied with this vision for dis- tance?' and if he or she tells us it's fine, this would be a good candi- date," he said. One reason why patient selec- tion for INTRACOR is important is because the procedure is not easy to reverse. "To reverse it would mean doing a kind of topography and a wavefront-guided surface excimer laser. It's not as easy to reverse it as taking a multifocal IOL out of the eye," Dr. Holzer said. Managing patient expectations As with all currently available pres- byopia treatment approaches, none can offer the same vision as patients had in their 20s, Dr. Holzer said. To prepare them for this, he spends time talking with them. "What I tell my patients is no matter what kind of procedure I per- form, they will be able to see near and distance, but they have to com- promise. The compromise could be, for example, a change in contrast sensitivity," he said. Patients need to know that with current presbyopia treatment proce- dures, good light conditions are im- portant. Patients always have a near point at a specific distance from the eye, and they need to adapt to this new situation, Dr. Holzer said. EW Editors' note: Dr. Hamilton has no financial interests related to his com- ments. Dr. Holzer has a financial inter- est with Technolas Perfect Vision. Dr. Jackson has financial interests with Abbott Medical Optics (Santa Ana, Calif.) and Allergan (Irvine, Calif.). Contact information Hamilton: hamilton@jsei.ucla.edu Holzer: +49 6221-566995, mike.holzer@med.uni-heidelberg.de Jackson: 613-737-8759, bjackson@ohri.ca continued on page 42

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