EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW REFRACTIVE SURGERY 54 January 2016 Dr. Teplick had no financial interests related to this article. Contact information Parkhurst: Gregory.Parkhurst@gmail.com Teplick: teplick@europa.com Thompson: vance.thompson@vancethompsonvision.com monovision and prolonged signifi- cantly more with inlay vision." Dr. Thompson has identified in- lay patients 8 years postop—up to 59 years old—who are still reading just as strongly at near and intermediate as they did immediately postop. An additional advantage is that inlay research has shown no reduction in stereoacuity, unlike in monovision. "Binocularity is maintained better with inlays than with mono- vision," Dr. Thompson said. "I con- sider the inlays a nice step forward in the world of corneal correction of presbyopia." Approved device The KAMRA inlay (AcuFocus, Irvine, Calif.), which is the only FDA ap- proved inlay, improves near vision in plano presbyopes by increasing the depth of focus utilizing a pin- hole technique. The inlay is placed in the non-dominant eye using a femtosecond laser to create a corneal pocket about 250 microns below the surface. The aperture of the inlay is 1.8 mm and its overall diameter is 3.8 mm. Unlike monovision, there is little or no effect on the patient's binocular distance vision, stereopsis or contrast sensitivity, according to studies. "The only choice between LVC and the inlay would be the choice between LVC monovision and the KAMRA," said Dr. Teplick, who was an investigational researcher for the device. "Monovision is a tradeoff between quality and convenience. Now that the inlay is part of our patient options, monovision is reserved for patients already happy with contact lens monovision and presbyopes with low myopic cor- rections who wear glasses only for driving or who don't wear distance correction at all." Most KAMRA patients need laser vision correction either preced- ing the inlay or at the same time, according to Dr. Teplick. FDA studies showed that the maximum number of patients achieving 20/20 and J3 have a postop MR of –0.50 to –0.75. "Presbyopes with this refraction do not exist commonly in nature, so we have to get them there either with LASIK preop (in our practice 1-month preop) or with LASIK/PRK at the time of KAMRA implanta- tion," Dr. Teplick said. EW Editors' note: Dr. Thompson has financial interests with AcuFocus. Dr. Parkhurst has financial interests with ReVision Optics (Lake Forest, Calif.). Laser continued from page 52 " It is an exercise in compromise when you are going to do a corneal correction of presbyopia. I want them to understand that even if we get their reading eye doing well, sometimes in the distance eye the near blur can affect the near image quality. " –Vance Thompson, MD