Eyeworld

EW FEATURE 84 Intracorneal inlays • March 2016 AT A GLANCE • With 1 intracorneal inlay FDA approved and 2 others undergoing clinical trials, this surgical option for presbyopia correction is an emerging frontier for ophthalmologists in the U.S. • Inlays can help extend spectacle independence, especially for emmetropes and those with prior laser vision correction. • Patient selection and centration of inlays are 2 of the biggest factors for success with these devices. by Liz Hillman EyeWorld Staff Writer (AcuFocus, Irvine, Calif.), which uses a small aperture effect to increase depth of focus. Other inlays with investigational status in the U.S. include the Raindrop (ReVision Optics, Lake Forest, Calif.) and Flexivue Microlens (Presbia, Dublin). monovision contact lenses, and multifocal or accommodating IOLs, but some patients might not con- sider these attractive alternatives to readers, Dr. Hovanesian said. "Most people have a bias against monovision—it just sounds unnatu- ral to them—even though it's a good strategy," he said. As of April 2015, another alter- native hit the market that might fill this gap: intracorneal inlays. The first and only inlay current- ly approved by the Food and Drug Administration (FDA) is the KAMRA The ins and outs of intracorneal inlays A retroillumination image of the Raindrop inlay in a human eye Source: John Hovanesian, MD What you need to know about this surgical option for correcting presbyopia E ach week, 1 or 2 patients ask John Hovanesian, MD, clinical instructor, Jules Stein Eye Institute, University of California, Los Angeles, how they could be freed from a dependence on reading glasses. He said he can appreciate their plight all the more now that he, admittedly, has joined the age group where presbyopia begins, prompting a reliance on some form of correction for near vision even for people who never needed glasses or contacts before. Corrective options beyond readers include monovision LASIK, Inlays versus refractive lens procedures Not all patients in the 45- to 60-year-old range are ideal for corne- al inlays. For example, if Dr. Hoopes has a patient who is 50 or older and hyperopic, he'll immediately consider him or her for refractive lensectomy. He also pays close attention to ocular scatter as measured by the AcuTarget HD (AcuFocus). "An ocular scatter above 1.5 tells me the lens is on the path to future cataract, and an inlay may not be the ideal procedure at this point," Dr. Hoopes said. There are various diagnostic tools that help assess who is a good inlay candidate—and who isn't, Dr. Thompson said. He uses the iTrace (Tracey Technologies, Houston) to quantify corneal and lens aberrations in addition to the HD Analyzer. Physicians interviewed for this article also contrast stage 1 (presby- opia with a clear lens) of dysfunc- tional lens syndrome versus stage 2 (presbyopia with early lens changes affecting image quality) patients when considering inlays. A stage 1 patient is potentially an inlay candi- date, while a stage 2 patient is often better for a lens procedure. "That's where quantifying lens aberrations is helpful," Dr. Thompson said. "If you measure corneal and lenticular ab- errations with the iTrace or measure high optical scatter index with the HD Analyzer, you'll know when it's best to tell patients with these early lens changes to do nothing and to continue with readers or consider a refractive lens exchange." Surgeons also must consider if there are any refractive treatments that can be done in tandem with the inlays to assist the patient, Dr. Durrie said. "I tell patients if they are candidates for the KAMRA and may be a little too hyperopic or astigmatic, I can correct that at the same time that I'm doing the inlay," he said. EW Editors' note: The physicians have financial interests with AcuFocus. Contact information Durrie: ddurrie@durrievision.com Hoopes: pchj@hoopesvision.com Thompson: vance.thompson@vancethompsonvision.com Who's continued from page 82

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