Eyeworld

55 EW FEATURE August 2016 • Presbyopia treatment Poll size: 198 continued on page 56 Dr. Garg agreed. "I think the concept of dysfunctional lens syn- drome gives us a construct to better explain presbyopia and the pro- gression to early cataracts," he said. "Patients need to understand that what they are experiencing is real and that they have options." Openly discussing the pathophysiology is a natural opportunity to discuss treat- ment options, Dr. Gupta noted. Latest options New technology continues to emerge. Laser vision correction in the form of presbyLASIK is one op- tion, Dr. Gupta pointed out. "That involves applying a laser treatment to induce spherical aberration to make the cornea more multifocal," she said. "There is extended range of vision." However, Dr. Gupta finds this option hasn't yet gained as much traction. "Future improve- ment in ablation profiles may make that more popular," she said. Corneal inlays are also an option for presbyopic patients. Dr. Garg said there are currently 2 cor- neal inlays that are FDA approved: the KAMRA (AcuFocus, Irvine, Cali- fornia) and, as of June 29, 2016, the Raindrop Near Vision Inlay (ReVision Optics, Lake Forest, California). With this increased availability, Dr. Garg thinks there will be more patients asking about the technology. This new addition to the armamentarium is likely to provide practitioners with another valuable tool in tackling presbyopia, he thinks. "With more than one op- tion, we may be better able to tailor the benefits of a particular tech- nology, depending on the patient's needs," Dr. Garg said. The 2 corneal inlays work very differently, he pointed out. "The KAMRA works by using a small ap- erture to extend the depth of focus while maintaining distance vision," he explained. "The Raindrop adds a refractive lenticule (hydrogel) to change the central refractive power of the cornea." Dr. Gupta said that also in the corneal inlay pipeline is the Presbia Flexivue Microlens (Presbia, Dublin), which doesn't rely on the pinhole Multifocal IOLs (including EDOF) Accommodating IOLs Corneal inlays Monovision Pharmacologic agents Appropriate patient expectations Concurrent management of astigmatism Concurrent management of ocular surface disease The tradeoff in optical quality for optical flexibility What do you think is the biggest obstacle to successful treatment of presbyopia? What approach to presbyopia treatment do you think holds the most promise for the future? In the 2015 ASCRS Clinical Survey, members were asked, "Not withstanding FDA approval status, which of the following presbyopia- correcting technology are you are most interested in integrating in the next 5 years?" Of the respondents, 63% were most interested in integrating extended range of vision multifocal IOLs into their practice in the next 5 years. Additionally, 35% were interested in light adjustable IOLs and 22% in shape changing IOLs.

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