Eyeworld

EW MEETING REPORTER 78 July 2016 Reporting from the BRASCRS annual meeting, June 1–4, 2016, São Paulo, Brazil Reporting from the BRASCRS 2016 annual A session at the annual meeting of the Brazilian Association of Cataract & Refractive Surgery (BRASCRS) focused on the topic of presbyopia, with presen- tations on tips, methods for cor- rection, and corneal inlays, among other topics. Dimitri Chernyak, PhD, Santa Clara, California, spoke about corne- al correction of presbyopia, discuss- ing methods, results, and future directions. "There are many ways to address presbyopia symptoms," he said. Unfortunately, there is no cure as of today. Potential treatment op- tions for presbyopia include correc- tions, ocular surface surgical proce- dures, and intraocular procedures, Dr. Chernyak said. Corrections could include using glasses or contact lenses. An ocular surface surgical procedure could be either a corneal procedure or a scleral procedure. An intraocular procedure option could include a lens exchange, multifocal IOLs, extended depth of focus IOLs, or accommodating IOLs. There are a number of pros and cons to using ablation approach- es like monovision, multifocal, or blended options, he said. Dr. Chernyak highlighted the value of optical modeling and adap- tive optics. Usually there's agreement be- tween optical modeling and perfor- mance, he said. But something that looks good as a simulation or on paper might not always work in a human subject, he added. Another tool is adaptive optics, he said, with the advantages that you don't have to cut any physical object, there are a variety of shapes, and there is the option for pupil size variety. However, patients are staring into a box, he said. In conclusion, Dr. Chernyak said that optical modeling is re- quired to develop corneal shapes with extended depth of focus and to limit expected CS/VA loss. Scleral lenses and adaptive optics systems are effective methods for validation of optical design, he added. Im- provements in distance corrected near visual acuity can be used for comparison of different correction methods in clinical trials. While monovision correction is a viable procedure for some patients, it does not fully address the entire presby- opia population, Dr. Chernyak said. Meanwhile, Steven Wilson, MD, Cleveland, spoke about his 20 years of experience with monovi- sion, a highly effective treatment for presbyopia. This is intentional retention or induction of myopia in 1 eye, and there are many options, including contact lenses, PRK, SMILE, LASIK, CK, LTK, and intraocular lenses. Dr. Wilson highlighted the different categories of monovision, including full monovision, moderate monovision, and partial monovi- sion. Full monovision may be for –2.5 D or greater myopia in 1 eye. It is designed to allow permanent uncorrected distance and reading vi- sion. Meanwhile, moderate monovi- sion is for –1.0 to –1.5 D of myopia in 1 eye. It's also for reading without glasses to approximately 55–60 years old and permanent better interme- diate distance vision. Finally, partial monovision is for –0.5 to –0.75 D of myopia in 1 eye, reading without glasses to approximately 50–55 years old, and permanent better interme- diate distance vision. Dr. Wilson highlighted candi- dates for monovision. These include a variety of patient types. First, Dr. Wilson said he discusses monovi- sion with all patients over age 40. Additionally, patients of any age who are motivated to postpone use of reading glasses as long as possible may be good candidates. He added that he typically excludes patients who are high-level athletes, those who are engineers, and those with type-A personalities. Never consider full monovision unless the patient has been successful with that level of anisometropia in contact lenses, he said.

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