Eyeworld

77 EW FEATURE AT A GLANCE • text goes here • text goes here • text goes here pattern, and without evidence of cataracts. Doctors can also implant the inlay in people who have had monofocal cataract surgery and per- form cataract surgery with the inlay in place, as well as in those who have had LASIK surgery and are now presbyopic, he said. "Key in patient selection is the measurement of ocu- lar light scatter as a metric of visual quality by means of the Acutarget HD technology (AcuFocus)." One issue to be aware of is dry eye or tear film dysfunction in these patients. When the inlay is in the cornea, it essentially reduces the pupil to 1.6 mm, so the tear film requirements are much more demanding, Dr. Fox said. "We encourage patients to lubricate aggressively and institute blinking exercises." Dry eye can be managed with punctal plugs, topical cyclosporine, artificial tears, and oral omega-3 supplements, Dr. Pepose added. Another factor to keep in mind is that while most LASIK patients will see well right away, KAMRA patients may require more care: The corneal pocket takes up to 4–6 weeks to heal in some individuals. "It is not like a LASIK expe- rience, and that's important for people considering getting into this to know," Dr. Fox said. "The typi- cal inlay response is an immediate improvement in near but a lagging clarity in distance vision that comes as the pocket heals." Be sure to monitor patients for a wound healing response, which can be treated with a course of topical corticosteroids, Dr. Pepose said. Physicians experienced with the KAMRA have also established that there is a refractive "sweet spot" where patients will get the best effect and the fastest results. That sweet spot is a refractive error of –0.5 to –0.75 D with no astigmatism or higher order aberrations, according to the doctors. "We're encouraging our pa- tients to consider the possibility of having excimer laser treatment (PRK or LASIK) either at the same time [of inlay implantation] or prior to KAMRA in a staged approach to bring them to that sweet spot," Dr. Fox said. An advantage of bringing patients to that sweet spot is that they will be able to tolerate the inlay better if it's a bit off-center. "One of the big challenges in placing the KAMRA inlay is having it lined up within 100 microns of the Purkinje reflection, and that's very tough to visualize," Dr. Fox said. "But if they're in that refractive sweet spot, they can be slightly off in terms of centration yet still enjoy excellent improvement in reading vision." Advice for new surgeons The doctors agreed that surgeons should work with patients to man- age their expectations. Let patients know that in low lighting situations they may still need to use reading glasses, the corneal pocket takes time to heal, and for some it will take time for them to neuroadapt to reading with their nondominant eye. "It's important to educate pa- tients about what their expectations should be, just as with any refractive procedure," Dr. Maloney said. "We're fond of saying, 'It took you 40 years to lose your reading vi- sion, so if it takes you a few months to gain it back, I think that's pretty reasonable,'" Dr. Fox said. According to Dr. Pepose, the surgery has a short learning curve, and any physician who has used the femtosecond laser to make LASIK flaps will pick it up very quickly. "Deep pockets of at least 200 microns with a tight line spot spacing are important in achiev- ing refractive stability and mini- mizing topographic changes," he said. "Also, entry site of the pocket should not be too anterior, as that may induce an astigmatic change." Dr. Fox thinks that within a year there will be an explosion of interest in this procedure, especially when patients learn how safe it is. "I think the word will start getting out," he said. "I think the KAMRA inlay represents the biggest advance in ad- dressing presbyopia since Franklin's 1784 bifocal." EW Editors' note: Dr. Pepose has financial interests with AcuFocus. Drs. Fox and Maloney have no financial interests related to this article. Contact information Fox: foxmd@laserfox.com Maloney: rm@maloneyvision.com Pepose: jpepose@peposevision.com stephensinst.com | +1.859.259.4924 Stephens Instruments | 2500 Sandersville Rd | Lexington KY 40511 USA Toll Free ( USA ) 800.354.7848 | Fax 859.259.4926 | info@stephensinst.com © 2016 Stephens Instruments. All rights reserved. LIFETIME WARRANTY 3 0 D A Y N O - R I S K T R I A L ISO 9001 ISO 13485 For more information visit us at ASCRS 2016 booth #1431 MICROSURE™ FEMTO TORIC S9-2070 S5-1535 ST5-7035 Stephens offers over 1,500 high-grade surgical stainless steel and titanium instruments, every one backed by a 30 day no-risk trial and lifetime warranty. You could pay more for your instruments, but why? Choose Stephens, trusted for over 40 years, and invest the savings in your practice—and your patients. The smart choice.

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