Eyeworld

79 EW FEATURE March 2016 • Intracorneal inlays because it was the first to get approv- al and has the highest volume." FDA clinical investigators found that the KAMRA inlay did improve near vision, with very little compro- mise to distance, Dr. Durrie report- ed. "I have patients who are 9 years postop and they're still seeing well, so it seems to be quite stable over time," he said, adding that this also works well with lens replacement. "You can leave the inlay in place and go to lens procedures and the depth-of-focus principle still works," he said. "That's comforting to both doctors and patients that you don't have to look at taking it out down the road once patients need a lens implant." On the other hand, it is not a problem if it does need to be removed. "That was one of the pos- itives that came out of the clinical trials—that if the inlay was removed, the patient returned to the preoper- ative best corrected vision in almost all cases," Dr. Durrie said. The negatives are that it's newer and more expensive for the patient than monovision and that neuroadaptation is required. "The vision isn't instantly recovered—it's recovered over the first month," Dr. Durrie said. "But patients don't seem to care because it's getting rid of their reading glasses. If they have to wear their reading glasses for a cou- ple more weeks and then get out of them, that's fine with them." In Dr. Durrie's experience, 15% of patients were out of their reading glasses as early as the first week, and everyone had reached that mark by the end of the first month. Dr. Tamayo mainly uses the Flexivue inlay. While he has used other inlays before, he likes the idea that with the Flexivue, the presbyopic correction is more in the periphery. "I think the decrease in contrast sensitivity with visual acuity is less with he Flexivue," he said, adding that contrast visual acuity decreases in all of the inlays, as well as all of the multifocals and other intraocular lenses. "It de- creases because it creates a change in the refraction from the center to the periphery," he explained. Dr. Tamayo prefers the Flexivue because it respects the center of the cornea. "It's a small center, but it respects this," he said. He reserves the inlays for emme- tropic patients with 20/20 distance vision who would like to correct their near vision and who are not older than age 56. "I consider the inlays as a factor to help the accommodation but not as a total replacement of accommodation," he said. "For patients older than 56, I do not consider inlays as a solu- tion." A second very important fac- tor is the patient's willingness to lose Because genetic eye diseases can attack the entire family, we treat the entire family. A special genetics team of physicians, researchers, genetics counselors and social workers help families plan the next steps in managing these rare diseases. We surround the patient and family with a network of care: choosing the right tests and diagnostic procedures, interpreting the results, making a diagnosis and then presenting the options. It can be a long road, but we're there the whole way. We're improving lives. 840 Walnut Street Philadelphia, PA 19107 www.willseye.org 1-877-AT-WILLS OCULAR GENETICS A FAMILY AFFAIR Alex Levin, MD, Chief, Pediatric Ophthalmology, & Ocular Genetics Service Jenina Cappasso, MS Genetics Counselor N.Wangtiraumnuay, MD Ocular Genetics Fellow OCULAR GENETICS A FAMILY AFFAIR a little bit of distance vision in the non-dominant eye in order to gain some near acuity. "Those patients who pass the test of monovision continued on page 80

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