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EW NEWS & OPINION 20 October 2015 thologies have subclinical functional damage that benefits from earlier intervention with the help of VEP and PERG. These include macular degeneration, epiretinal membranes, diabetic retinopathy, macular edema, glaucoma, and more. In addition, we perform these tests on patients seeking multifocal intraoc- ular lenses. It is helpful to know if patients have any defects or existing loss of contrast sensitivity prior to implanting multifocal lenses. In one specific case, a cataract patient interested in premium lens options reported prior optic neuritis in one eye due to multiple sclerosis, but did not remember in which eye. Upon testing the patient with VEP, one eye had normal latency and amplitude while the other was out- side the reference range. We adapted our IOL recommendations for this patient to avoid any post-surgical surprises and buyer's remorse. Good vision is dependent on so much more than healthy rods and cones. It is very exciting to have the ability to bring electrophysiology to the clinic to measure the function of patients' vision and positively in- fluence our daily medical decisions. Electrophysiology gives me a greater understanding of each patient's needs and improves our ability to care for them. EW References 1. Pillai C, Ritch R, Derr P, et al. Sensitivity and specificity of short-duration transient visual evoked potentials (SD-tVEP) in discriminating normal from glaucomatous eyes. Invest Oph- thalmol Vis Sci. 2013;54:2847–2852. 2. Banitt MR, Ventura LM, Feuer WJ, et al. Pro- gressive loss of retinal ganglion cell function precedes structural loss by several years in glaucoma suspects. Invest Ophthalmol Vis Sci 2013:54:2346–2352. 3. Saleh M, Nagaraju M, Porciatti V. Longi- tudinal evaluation of retinal ganglion cell function and IOP in the DBA/2J mouse model of glaucoma. Invest Ophthalmol Vis Sci. 2007;48:4564–4572. 4. Ventura LM, Porciatti V. Restoration of retinal ganglion cell function in early glaucoma after intraocular pressure reduction: a pilot study. Ophthalmology. 2005;112:20–27. 5. Sehi M, Grewal DS, Goodkin ML, Greenfield DS. Reversal of retinal ganglion cell dysfunc- tion after surgical reduction of intraocular pressure. Ophthalmology. 2010;117:2329– 2336. Editors' note: Dr. Tyson has no finan- cial interests related to this article. Contact information Tyson: tysonfc@hotmail.com THE PRESBYOPIA SOLUTION THEY'VE BEEN WAITING FOR. The KAMRA inlay provides a full range of vision and long-term performance, while leaving the natural lens in place. Indications for Use: The KAMRA inlay is indicated for intrastromal corneal implantation to improve near vision by extending the depth of focus in the non-dominant eye of phakic, presbyopic patients between the ages of 45 and 60 years old who have cycloplegic refractive spherical equivalent of +0.50 D to -0.75 D with less than or equal to 0.75 D of refractive cylinder, who do not require glasses or contact lenses for clear distance vision, and who require near correction of +1.00 D to +2.50 D of reading add. KAMRA; the KAMRA logo; Across the page. Across the room. Across the years; and The Presbyopia Solution are trademarks of AcuFocus, Inc. ©2015 AcuFocus, Inc. MKU-157 Rev D Mean near acuity improved about 3 lines to 20/25 at 1 month and was maintained over the 5 year follow-up. The US pivotal clinical study data reported an average gain of about 3 lines of near visual acuity.** *Dexl AK et al. Long-term outcomes after monocular corneal inlay implantation for the surgical compensation of presbyopia. J Cataract Refract Surg. 2015 Mar;41 (3):566-75. **PMA data on file at AcuFocus, Inc. 20/200 20/125 20/80 20/50 20/32 20/20 20/12.5 0 10 20 30 40 50 60 SNELLEN ACUITY MONTH UNCORRECTED NEAR VISUAL ACUITY (INLAY EYE ONLY)* INLAY EYE J2 Across the page. Across the room. Across the years. Visit us at AAO Booth #728 ® Electrophysiology continued from page 19 are maintaining the health of the ocular pathway. If it is degrading, I know we may need to alter care. For example, 18 mm Hg may be a good target pressure in some patients, while in others it may simply be too high. PERG data results help to take the guesswork out of my job. We have had several patients that maintained an IOP of 22 mm Hg in one eye and 25 mm Hg in the other eye consistently for up to 3 years, with normal results on visual field and OCT testing. When I first got the Diopsys NOVA Vi- sion Testing System I tested these patients for subclinical changes to their retinal function. On one such patient, I found that the VEP results were normal in the eye with a pressure of 22 mm Hg, but saw a loss of amplitude and a delay in the low contrast latency measurements on the other eye, results specific to glaucoma. We initiated treatment and after 6 months of prostaglandin, the patient had normalization of the waveform and improvement of the signal. It is exciting to be able to treat patients at a point where this is still potential for improvement, rather than just maintenance. We have found VEP and PERG testing to be useful beyond its known uses for malingering and multiple sclerosis. Many other pa-

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