EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW REFRACTIVE SURGERY October 2014 69 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer central, the other peripheral. Both cases resolved, with their uncorrect- ed distance visual acuities at 20/20 and 20/30 at their latest clinic visits. Three cases had moderate haze appearing 2 to 3 months postop, one case due to noncompliance with postop steroid therapy. Haze resolved in all cases with steroid treatment, and visual acuity was unaffected. In summary, said Dr. Joo, functional binocular visual acuities were achieved in their Asian patient population, 20/25 for binocular near C orrecting presbyopia remains a challenge to modern ophthalmic surgery. Over the years, various solutions have been proposed, from accommodat- ing IOLs on the lenticular plane to extending the depth of field with corneal inlays or by changing the shape of the cornea—typically with laser surgery—on the corneal plane. The Raindrop Near Vision Inlay (ReVision Optics, Lake Forest, Calif.) reshapes the cornea by adding volume to the center. The inlay's proprietary hydrogel material is almost 80% water, allowing nutrient distribution through the corneal tis- sue while giving it a refractive index that matches that of the cornea. The Raindrop measures a mere 2.0 mm in diameter, 32 µm in thick- ness, but implantation results in a prolate cornea, with more power in the center for near vision, gradually decreasing toward the periphery for intermediate and distance vision. Choun-Ki Joo, MD, PhD, South Korea, is one of 11 surgeons —5 from 4 clinics in South Korea, 6 from 1 high-volume LASIK clinic in Japan—who have had experience with the new corneal inlay. Dr. Joo shared the combined experiences of these surgeons in an interview with EyeWorld. Study results Their study included 125 Asian patients averaging 51.3±4.4 years. The inlay induces mild myopia of about –0.75 D, so in Caucasian eyes the refractive target of concur- rent LASIK in the inlay eye is gener- ally +0.75 to compensate. However, Asian patients, said Dr. Joo, tend to prefer closer reading distances. Dr. Joo and his fellow surgeons thus set the refractive target for the concur- rent LASIK in the inlay eye in these patients at +0.25 to +0.50 D. Because they performed LASIK concurrently with inlay implanta- tion, the procedure involved making a flap. o accommodate the inlay, the flap is made slightly thicker than usual for LASIK—around 151±14 µm compared with 100 to 110 µm in standard LASIK, said Dr. Joo. In their experience, eyes under- going LASIK with Raindrop inlay im- plantation had stable visual acuities 1 week postop. At 3 months postop, near visual acuities went from 20/63 preop to 20/40 or better in 86% of patients and 20/25 or better in more than half (52%) of patients; binoc- ularly, uncorrected distance visual acuity (UDVA) was unaffected by the implant, with 92% of patients at 20/20 or better. Visual acuities remained stable up to 6 months, the limit of the combined data at the time of the interview. There were some "minimal" complications, said Dr. Joo. Two cas- es had mild striae after surgery—one and 20/16 or better for binocular distance. Monocular distance vision was not greatly compromised, with 65% having 20/40 or better UDVA. Complications were low, with no significant consequences Other technologies Before being introduced to the Raindrop, Dr. Joo said that he had tried other methods of presbyopia correction, including other inlay technology and other laser pres- byopic treatments, "but in laser presbyopic treatment, there is some tendency of regression," he said. Patients who undergo laser presby- opic treatment, he said, are satisfied postoperatively, but 6 months to a year later, they are disappointed. Ultimately, "Raindrop is a safe and effective tool for treating presbyopia in the Asian patient population," Dr. Joo concluded. EW Editors' note: Dr. Joo has no financial interests related to his comments. Contact information Joo: ckjoo@catholic.ac.kr Raindrop Near Vision Inlay clinical results in Asian eyes An eye after Raindrop implantation. The inlay is virtually invisible to the naked eye. Source: Choun-Ki Joo, MD, PhD The Raindrop Near Vision Inlay reshapes the cornea by adding volume to the center. The inlay's proprietary hydrogel material is almost 80% water, allowing nutrient distribution through the corneal tissue while giving it a refractive index that matches that of the cornea.