Eyeworld

Reporting from the XXXIII Congress of the ESCRS, September 5–9, Barcelona EW MEETING REPORTER 150 October 2015 grow in the coming decade, with factors in play like the aging global population, growing affluence, and improvements in technology. The growth has slowed in the market for premium and elective procedures, he said, and a modest market penetra- tion is still a significant opportunity. Presbyopia is a complicated topic that everyone is talking about, said Pablo Artal, MD, Murcia, Spain. His presentation focused on binocular approaches, which he believes are the best for presbyopia correction. He highlighted adaptive optics visual simulators, which are new in ophthalmology, but Dr. Artal thinks they will play an important role in the future. This is basically a wavefront sensor and aberrometer, he said, but it also allows the sur- geon to induce different profiles into the eye to pretest possible solutions. Dr. Artal said that acuity, sum- mation, contrast, and stereopsis are all important factors to consider when aiming for the best visual outcomes. Customization with an adaptive optics visual simulator could help to optimize these results, he said. Multifocal IOLs and advanced optics George O. Waring IV, MD, Charles- ton, S.C., focused his free paper pre- sentation on the change in forward light scatter after implantation of strain on tear film is higher for this procedure than for standard LASIK. Now that corneal inlays have reached the market, what have surgeons learned from implant- ing them? Reviewing the relevant literature, Günther Grabner, MD, Salzburg, Austria, showed that cor- neal inlays are a safe, effective, and minimally invasive solution to pres- byopia. Although the effects of the inlays are not completely reversible, they can be removed if the patient is unhappy or has complications, Dr. Grabner said. The most data available is on the KAMRA small aperture inlay (AcuFocus, Irvine, Calif.), which has been implanted in more than 20,000 eyes worldwide. When implant- ing the device, there is a refractive "sweet spot" that gives patients the best distance and near vision, Dr. Grabner said. When the postop spherical equivalent is –0.5 to –0.75 diopters, 92% of patients have 20/20 or better distance vision and J3 near vision, so if you hit this sweet spot, you'll have excellent results, he said. Presbyopia workshop A presbyopia workshop session examined the issue in depth. In his introduction, Ioannis Pallikaris, MD, Crete, Greece, said that the demand for surgical correction of presbyopia is still only in its in- fancy stage. He expects demand to many strides in bringing them from a concept to a reality. Gerd Auffarth, MD, Heidelberg, Germany, described the spectrum of lens-based options that are currently in development. One option is to fill the capsular bag with a fluid or use a hydrogel that takes up the entire volume of the bag, and the other option is to use a movable implant or system that changes shape or position. Movable lenses in develop- ment include single- and dual-optic lenses that provide near vision by shifting position anteriorly and flu- id-filled lenses that can change their curvature. Reviewing the available litera- ture, Dr. Auffarth showed that cur- rent single-optic lenses only slightly increase the depth of focus—their accommodative range might be a quarter diopter, but not much more. Dual-optic systems provide a slightly larger range, but they also have a limited effect on vision. Lenses that change curvature are promising, he concluded, but are not yet ready for large-scale implantation. Cornea-based solutions for presbyopia Surgeons have two cornea-based options for presbyopia correction— monovision LASIK and corneal inlays. Also during the presby- opia session, Michiel Luger, MD, Utrecht, the Netherlands, shared with attendees his experience with monovision LASIK using the PresbyMAX Hybrid laser system (Schwind, Kleinostheim, Germany). The PresbyMAX Hybrid system enables the surgeon to do a modified micro-monovision technique where one eye is focused at near and one at distance, but each eye has a different depth of focus, providing better in- termediate vision than micro-mono- vision alone. Dr. Luger has found the PresbyMAX system to be safe and effective in giving patients a full range of vision, but patient selection is crucial to success, he said. Can- didates must be motivated and ex- tremely patient because it may take time for their vision to stabilize after surgery. Patients must have an excel- lent tear film, he added, because the View videos from Tuesday at ESCRS 2015: EWrePlay.org Ehud Assia, MD, discusses surgical techniques for fixating subluxated IOLs.

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