Eyeworld

EW FEATURE 56 effect. It uses rings with powers that progress from +1.50 to +3.50 D, surrounding a central plano zone to create a multifocal cornea. As with other corneal inlays, there is a laser pocket that is created and then the inlay is applied to the cornea and centered over the pupil, Dr. Gupta explained. She likes the idea of the corneal approach in general. "I think it's a novel concept to have presby- opia correction in the cornea," she said, adding that the clinical trials have shown these to be reasonably safe and provide a number of pa- tients with a greater range of vision. Also in the pipeline is the FluidVision lens (PowerVision, Belmont, California). Dr. Gupta described this as an accommodating intraocular lens. This IOL relies on the eye's ciliary body to move fluid in and out of the optic and change the lens' shape. "It helps to restore accommodation so that patients can get that broader range of vision," Dr. Gupta said. Another option is the Tecnis Symfony IOL (Abbott Medical Optics, Abbott Park, Illinois), an extended depth of focus lens. "It has been available in Europe for some time and patients are getting excel- lent vision with it," Dr. Gupta said, adding that such lenses can help to mitigate some of the issues that patients have with multifocals such as glare and halos or contrast vision loss. While they might not have as good near vision, patients are often happy because the quality of vision is not compromised as much and they still get reasonable near acuity, she explained. The Tecnis Symfony lens smooths out the defocus curve by creating one elongated focal point rather than a small area of single focus with a typical monofocal lens or 2 distinct focal points for near and far, Dr. Gupta said. "It's a blend between a multifocal and monofo- cal," she said. Dr. Garg views this as an ex- citing option. "The unique way in which the lens elongates focus will allow for extended range of vision without dead zones in the patient's vision," he said. "The optical quality is also enhanced by chromatic ab- erration correction, which is greater than the natural crystalline lens." Additionally, in clinical trials the IOL appeared to be more resistant to residual astigmatism and refractive misses. Another exciting technology is the Light Adjustable Lens (Calhoun Vision, Pasadena, California), Dr. Garg said. If this works as practi- tioners hope, it will allow them to precisely attain and if necessary change refractive powers, while in the patient's eye. "This flexibility will allow us to try monovision and change the focal point if needed," he said. "I'm hopeful there will be a presbyopia-correcting Light Adjustable Lens platform as well." Dr. Gupta pointed out that there are non-surgical treatments emerg- ing for presbyopia. Currently there are 3 drops in trials: EV06 (Encore Vision, Fort Worth, Texas), PRX-100 (Presbyopia Therapies, Coronado, California), and PresbV Tears (Po- payán, Colombia). "These are new pharmacological agents that stim- ulate miosis without accommoda- tion," Dr. Gupta said. The issue with drops that stimulate miosis without accommodation is that patients lose their distance vision as the result of a myopic shift. In addition, they may feel as if their peripheral vision is very narrow and of poor quality until the drop effect wears off, Dr. Gupta explained. "What's interesting about all 3 drops is that preliminary results are showing that patients have improved near and intermediate vision without distance compromise," she said. Overall, Dr. Gupta is most excit- ed about the future of non-surgical options, but also thinks that the corneal inlay technology is contin- ually improving. "The KAMRA is a great solution at the moment and as other types of inlays are developed, I think they will have an appeal to pa- tients in the sense that they're very similar to the LASIK-type procedure patients are familiar with," she said. "Inlays are not overly invasive, and from the data we've seen, patients are achieving good near vision. I think this is an area that's going to expand." Dr. Gupta envisions many products in each category emerging in the future. "There isn't going to be just one corneal inlay, one eye drop, one multifocal implant, or one extended depth of focus implant. I think there is going to be a lot of innovation in this area, and it's going to continue to get better," she concluded. EW Editors' note: Dr. Garg has financial interests with Abbott Medical Optics (Abbott Park, Illinois). Dr. Gupta has financial interests with Abbott Medical Optics and Alcon (Fort Worth, Texas). Contact information Garg: gargs@uci.edu Gupta: preeyakgupta@gmail.com Future continued from page 55

• Cover