Eyeworld

Reporting from the 2017 EyeWorld Surgical Summit, February 2–4 2017, Park City, Utah EW MEETING REPORTER 134 Reporting from the 2017 EyeWorld Surgical Summit, February 2–4, 2017, Park City, Utah technology, with results looking good by the numbers but with some dissatisfaction among patients. For this reason, it's important to manage expectations of patients, she said. She shared her pearls for corneal inlays, including evaluating the ocular surface ahead of time. Dr. Wolsey also recommended a contact lens trial. Patient selection for this technology is key, she added. Stay on label and tread lightly, Dr. Wolsey said. "This is a foreign body in the cornea, so if something is going on you need to act aggres- sively." She also stressed the im- portance of postoperative care with frequent visits. You want to follow these patients closely to make sure you're not missing any inflamma- tion, she said. Dr. Wolsey said that she likes both inlays for different reasons. KAMRA uses a pocket and is less invasive and available to more patients, she said. Raindrop, on the other hand, is an easier surgery and vision recovers more quickly. When using these corneal inlays, you need to be committed, Dr. Wolsey said. You need to have an adequate volume, and you need to be willing to do some handholding, she added, but it's possible to make some very frustrated presbyopes happy. Editors' note: Dr. Wolsey has no rele- vant financial interests. MACRA update Also during Friday morning's session, Nancey McCann, Fairfax, Virginia, the ASCRS•ASOA director of government relations, gave an update on the Medicare Access and CHIP Reauthorization Act (MACRA). There has been a bipartisan effort aimed at moving Medicare payment into a system based on outcomes, quality, and efficiencies, she said. MACRA, Ms. McCann said, was developed in a bipartisan, bicameral process. It was supported by over 750 national and state-based phy- sician organizations and passed by both the House of Representatives and the Senate. MACRA permanent- ative dysphotopsia in a study involv- ing placement of 72 Masket ND IOL Type 90S lenses, Dr. Masket said. Editors' note: Dr. Fram has financial interests related to her comments. Dr. Masket has financial interests with Morcher. Refractive surgery and more Corneal inlays were a topic of discussion during Friday morning's sessions. Darcy Wolsey, MD, Salt Lake City, highlighted informa- tion about these inlays, specifically discussing how to add them into your practice and her early experi- ence using inlays. There are two to choose from, she said, the KAMRA (AcuFocus, Irvine, California) and the Raindrop (ReVision Optics, Lake Forest, California). First, she said it's important to know if you're ready to use this technology. You need to be able to do femtosecond laser flaps and pock- ets and be able to use topography/ tomography, she said. Dr. Wolsey said it's important to get the clinic set up correctly. This includes educating your refractive team, having a script for phone inquiries about the inlays, being comfortable explaining the tech- nology, and understanding who is a good candidate. Dr. Wolsey then discussed the differences between the KAMRA and Raindrop and how these two inlays compare. Both are approved for similar ranges, she said, though they differ slightly. KAMRA is approved for patients who have had previous LASIK or PRK, while Raindrop is not. The KAMRA is placed in a pocket, which results in less dry eye, no flap issues, and risk for ectasia is unlikely. Meanwhile, the Raindrop is placed under an 8 mm flap, and it is more invasive, may have some flap issues, and may pose a risk for ectasia. KAMRA is technically more difficult because it's harder to get the perfect position, Dr. Wolsey said, while the Raindrop is technically easier, as it is easier to place in the center of the pupil. Dr. Wolsey said she has had mixed results so far using the IOLs in response to this association with positive dysphotopsia. Still, if a patient is complaining of this condition, current treatment includes pharmacological agents— brimonidine 0.15% or pilocarpine 0.5%—or removal and replacement with a different IOL material. In a sample of 30 eyes with this condition, Dr. Fram reported an 80% (12/15) improvement in patients switched from an acrylic IOL to silicone, 88% (15/17) improvement in patients switched from acrylic to collamer, 0% (0/1) improvement in a switch from one acrylic to another, and a 100% (1/1) improvement in a switch from a collamer to PMMA. If the patient is complaining of both negative and positive dys- photopsia, both a material change and different placement of the lens might be in order. Specifically, research by Dr. Fram and Samuel Masket, MD, Los Angeles, suggests placing the optic above the ante- rior capsule—reverse optic capture (ROC)—or in the sulcus can solve negative dysphotopsia issues. Dr. Masket delved more into negative dysphotopsia, saying that he believes the relationship between the nasal anterior capsule and an- terior surface of the optic are chief factors to this condition. Describing surgical experience in 43 patients, 57 eyes (65 proce- dures), Dr. Masket said from a ther- apeutic standpoint, ROC resolved negative dysphotopsia 100% of the time (21/21 cases). IOL exchange— placing the IOL in the sulcus instead of in the bag—improved symptoms in seven out of eight patients, while piggyback IOL improved symp- toms in eight out of 11 patients. Symptoms did not improve in any patients who received an IOL exchange with placement again in the bag (0/5 patients). In terms of preventative negative dysphotopsia, Dr. Masket said the ROC technique worked 100% of the time. Dr. Masket noted an anti-dys- photopic lens—the Masket ND IOL Type 90S (Morcher GmbH, Stuttgart, Germany)—which is a capsulotomy supported IOL that allows some of the lens to remain anterior to the capsule. There were no cases of neg- March 2017 continued on page 136 Sponsored by

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