Eyeworld

87 EW FEATURE March 2016 • Intracorneal inlays EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put "EW Pulse" in the subject line. Poll size: 167 by Ellen Stodola EyeWorld Staff Writer AT A GLANCE • Patient counseling approaches with corneal inlays may include a patient counselor or having the surgeon and/or office staff involved heavily in the preparation, procedure, and follow-up. • Dry eye, a foreign body reaction, and decentration issues are among the possible problems that could occur, but the corneal inlay can be removed if necessary. • There is currently one FDA-approved inlay, with others in trials and at various approval stages around the world. Managing patient expectations with corneal inlays phy, refraction, and astigmatism. Many things are the same and some are different, Dr. Whitman said, as you're trying to give patients better reading and computer range vision without doing much to change their distance vision. Approach to corneal inlays Dr. Waring said that the approach to corneal inlay patients is similar to how he would approach a LASIK patient. "We have tracks in our cataract and refractive surgery prac- tice," he said, and determining the treatment track is often based on the patient's age. involved in the education process. Often adoption of a new tech- nology includes a staged implemen- tation that can help in developing internal treatment algorithms for these new products. "I may spend extra time counseling a patient when we first acquire a new tech- nology," Dr. Waring said. As patient volumes with the new technology increase and there is a better under- standing of the nuances, it may shift to the staff to become more in line with traditional counseling proto- cols. "We have counselors that we use for laser and cataract surgery, so they're involved in this in the same way," Dr. Whitman said. These counselors have been educated about the inlays, who the best can- didates are, who is not a candidate, and a number of other points. Dr. Whitman does a contact lens trial where a patient will test out a reading lens or progressive add lens in the eye that is going to be treated. This helps the surgeon to see if patients can tolerate any differ- ences between their eyes. "It doesn't simulate an inlay but gives them an idea of having subtle differences between their eyes," he said. Counselors do preliminary autorefraction, looking at the tear film, as well as a contact lens trial, Dr. Whitman said. If the patient continues on, there would be a workup similar to LASIK, looking at corneal topogra- C orneal inlays are a new technology to help improve vision in some patients with presbyopia. George Waring IV, MD, associate professor of ophthalmol- ogy, director of refractive surgery, Storm Eye Institute, Medical Uni- versity of South Carolina, and medical director, Magill Vision Center, Charleston, S.C., and Jeffrey Whitman, MD, president and chief surgeon, Key-Whitman Eye Center, Dallas, discussed how to counsel pa- tients with this new technology and other issues that must be addressed. Patient counseling When it comes to patient counsel- ing for advanced technologies, Dr. Waring said there are a few different approaches a practice may take. "Each practice is going to have a unique approach to this based on what type of practice it is," he said. One approach to patient counseling is where the primary responsibility will fall either on the surgeon or on a patient coun- selor, or it could be a combination of the two. Some practices take a more holistic approach so that each person who comes in contact with the patient is educating him or her in different areas along the way, Dr. Waring said. However, he noted that this approach may be particular to a more established technology. When there's a new technology, the surgeon may be called on to be more An eye immediately postop after Dr. Waring placed a KAMRA inlay Source: George O. Waring IV, MD continued on page 88

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