Eyeworld

EW FEATURE 86 Intracorneal inlays • March 2016 Monthly Pulse Intracorneal inlays T he topic of this Monthly Pulse survey was "Intracorneal inlays." We asked, "Do you currently implant corneal inlays?" and the majority of respondents to this survey said "no." For the respondents who answered "yes," we asked, "Overall, how satisfied are your corneal inlay patients with their night/intermediate/near vision at 1 year postop?" For night vision, the majority of respondents said their patients are "neither satisfied or unsatisfied." For intermediate vision, the majority of respondents said their patients are "very satisfied." When asked about patient satisfaction with near vision, there was a tie between "somewhat unsatisfied" and "neither satisfied or unsatisfied." Finally, we asked, "For qualified patients ages 45–54 with no astigmatism, what do you think will be your primary surgical presbyopia correction solution(s) in the next 3 years? (Select up to 3 options)." The top 2 answers were multifocal IOLs and laser vision correction monovision. vision, Dr. Wiley said. A patient with an existing inlay needing some sort of refractive enhancement later could have LASIK or PRK done, but Dr. Wiley said these procedures would likely happen simultaneously or before. Patients with inlays who de- velop cataracts later in life will also be able to maintain the inlay with the ophthalmologist selecting the correct IOL to work well with it. Who isn't a good candidate? "In general, anyone who isn't a good candidate for refractive surgery is not a good candidate for corneal inlays," Dr. Wiley said. "That may include people with thin corneas, dry eye disorders, inflammatory or autoimmune disorders, and people who are critical observers and might not … enjoy a different optical system." Healing, complications, and comparisons In terms of healing, Dr. Lindstrom said surgeons need to manage wound healing of the ocular sur- face, and there is a neuroadaptive aspect for patients. Dr. Hovanesian said inlay patients might require a longer follow-up period than LASIK patients to ensure they are still toler- ating the device well. Dr. Lindstrom said it takes anywhere from a few weeks to a few months for patients to realize the full benefit of the inlays, but Dr. Hovanesian said those who have received it in his practice are still "really excited about how immediate the results are." While all the physicians inter- viewed said complications from the inlay procedure and the device itself are rare, some of the most common problems include decentration of the inlay, dry eye, and neuroadap- tation issues. The inlays could also cause halo or glare in some patients. "Time, reassurance, and adap- tation would help with that. But I suppose there are patients who may never tolerate it, and the inlay may need to be removed. I have not had to remove any yet," Dr. Wiley said. The beauty of the inlay is that it can be easily removed with the pa- tient's vision reverting back to where it was at the time of the original surgery, Dr. Hovanesian said. As for how the inlays compare to other presbyopia-correcting pro- cedures, Dr. Wiley said that an inlay like the KAMRA would continue to perform as a patient's vision ages, while LASIK with monovision, for instance, "is a one-time situation that only has a certain range of correction." A multifocal IOL has similar pros and cons to inlays, Dr. Wiley said. While IOLs would also func- tion well over time as a patient ages, they might not be the best option for patients who don't tolerate multifocal vision well. The opportunity Dr. Wiley said inlays present an opportunity not just for patients who have presbyopia now, but for those who haven't developed it yet. According to the "Global Presbyopia-Correcting Surgery Market Report," more than 2 billion people worldwide will be presbyopic by 2020, making it an almost inevi- table condition for all adults at some point in their 40s and beyond. 2 "If you look at the aging pro- cess, right now if a 30-something- year-old comes in with nearsight- edness and wants to have LASIK, they'll say 'Great, but should I really get LASIK because in 10 years I'm going to need glasses anyway?'" Dr. Wiley said. "Now we can say we have a solution for that, you can either do monovision or you can do a corneal inlay; we now have things that can be added onto LASIK that can extend the life [of that vision] without needing glasses." Dr. Wiley thinks that the advent of inlays will give younger patients the confidence they need to decide to invest in LASIK, knowing that they won't necessarily be limited by glasses again in the future. For the patient who has already invested in LASIK, this procedure could give them continued independence from glasses. "They say that technology reaches its peak when it becomes invisible, and inlays are an invisible technology that rests in the eye and gives an ability that you would otherwise have lost with age," Dr. Hovanesian said, adding that he thinks "surgeons who are serious about laser correction should learn more about [inlays and] should offer this technology so they're providing a complete spectrum of care. You can't be a full-service LASIK surgeon and not offer inlays." EW References 1. Seyeddain O, et al. Small-aperture cor- neal inlay for the correction of presbyopia: 3-year follow-up. J Cataract Refract Surg. 2012;38:35–45. 2. Market Scope. Global Presbyopia-Correcting Surgery Market Report. 2012. Editors' note: Dr. Hovanesian has fi- nancial interests with ReVision Optics, Alcon (Fort Worth, Texas), and Abbott Medical Optics (Abbott Park, Ill.). Dr. Lindstrom has financial interests with AcuFocus, Alcon, Abbott Medical Op- tics, and Bausch + Lomb (Bridgewater, N.J.). Dr. Wiley has financial interests with AcuFocus, Presbia, ReVision Op- tics, Abbott Medical Optics, and Alcon. Contact information Hovanesian: johnhova@gmail.com Lindstrom: rllindstrom@mneye.com Wiley: drwiley@clevelandeyeclinic.com The ins continued from page 85

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