Eyeworld

99 EW FEATURE March 2017 • Advances in corneal inlays Cataract implications Dr. Waltz noted that when the natural lens is replaced, it improves the function of the KAMRA, and he get monovision at 50, often you'll get about 1 D of myopia to help with the loss of accommodation. It's something that works for a period of time and works pretty well but ultimately you will need something else." Dr. Waltz noted that the greater the patient's presbyopia, the less well corneal inlays work. Dr. Wiley leans toward a clear lens exchange in patients in their 40s with higher prescriptions, such as +4 D or +5 D. In such patients he uses an extended depth of focus lens, often in the dominant eye. After assessing the visual function in the first eye, he matches it with either a Symfony lens (Abbott Medi- cal Optics, Abbott Park, Illinois) or a traditional multifocal in the second eye. "We find that the extended depth of focus lens gives great in- termediate and distance vision but sometimes does not deliver the near vision that patients are looking for," Dr. Wiley said. "So in the second eye we consider doing more of a tradi- tional multifocal to bring in better near vision." Dr. Waltz said some surgeons follow the "rule of eight," in which they consider clear lens removal rea- sonable in patients who score eight or more in a grading system, which includes one point for every decade of life and one point for every diop- ter of hyperopia. "That gives an upper border for when it is time to think about lens surgery instead of an inlay," Dr. Waltz said. Stages 2 and 3 Corneal inlays drop off Dr. Pepose's algorithm among eyes in stage 2 DLS, which are those with moderate scatter. "I consider monovision or blended vision LASIK, with an explanation that this will not end the aging process and eventually cataract surgery will be required," Dr. Pepose said. Additionally, stage 2 patients could consider cataract IOLs options and possibly benefit from a premi- um IOL, he said. For stage 3 DLS, which includes significant scatter, cataract surgery is indicated, and Dr. Pepose assesses the patient's vocation and avoca- tion, biometry, angle kappa, corneal wavefront, macular function, and ocular surface. Additionally, Dr. Pe- pose discusses the best IOL option or combination for each patient. The older the patient (and thus, the increased likelihood of cataract formation), the more Dr. Wiley leans toward a lens procedure instead of a corneal procedure. "If their lens is showing scat- ter, like an AcuTarget [AcuFocus] showing that they already having optical quality decrease in addition to the presbyopia demonstrated by the objective measure of the device, then we will lean more toward a lens procedure," Dr. Wiley said. "But usually it is dictated by age. So the older they are, the more we will lean toward lens replacement, rather than corneal surgery." anticipates the same result with the Raindrop. "One of the nice things about treating [DLS] with this is that you View of posterior subcapsular cataract shows how it interferes with patient vision. Source (all): Kevin Waltz, MD continued on page 101

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