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EW NEWS & OPINION 12 March 2017 World view Corneal inlays come of age P atients looking to address presbyopia will find more options than ever before. There are established options like monovision, achieved with a contact lens or through laser vision correction with PRK, LASIK, or SMILE. Multifocal IOL tech- nology is better than ever, with low-add multifo- cals and extended depth-of-focus implants. But, there are, of course, advantages and disadvantag- es to each technology. Many patients receiving intracorneal inlays, a relative newcomer to the presbyopia-correcting market, are achieving Snellen uncorrected vision in the 20/20 to 20/25 range. But this technology is still somewhat of an exercise in compromise since there can be mildly reduced contrast sensitivi- ty, which is why they're placed in only one eye. Even though visual acuity is not the same as an eye without an inlay as far as the image quality, the slight reduction in contrast sensitivity in the treated eye compared to the large reduction experienced with monovision, is typically tolerated much better. Our understanding of corneal inlays has grown since the primary work of Jose Barraquer, MD, and others, as discussed by Richard Lindstrom, MD. The unique characteristics of the various implants of today are viewed by Ralph Chu, MD, Dan Durrie, MD, Jeff Whitman, MD, and Ed Manche, MD. All these inlays respect the corneal physiology principles that have been discovered over the years, but also have unique optical principles to achieve their presbyopic correction. The pros and cons of corneal inlays are examined by John Vukich, MD, Jay Pepose, MD, Damien Gatinel, MD, and Robert Maloney, MD. In general, we want to see our patients happy with the corneal inlay result by 6 months or else it can be removed. Removability is indeed a positive feature of corneal inlays. However, biocompatibility can be an issue, which is why maximizing patient satisfaction can be a sign of a biocompatible situation and if not achieved, the inlay can be removed. Techniques to maximize the extremely important preoperative exam and patient selection are described by Lance Kugler, MD, and myself. Modern day technologies to help rule out issues such as tear film abnormalities or early lenticular changes are discussed by Dr. Durrie and Gary Foster, MD. It is important to always consider other presbyopia-correcting options as well, such as the various monovision techniques and multifocal implants, as discussed by as discussed by Dr. Pepose, William Wiley, MD, and Kevin Waltz, MD. Modern day surgical technology, such as the femtosecond laser, has also made the corneal inlay procedure better, as discussed by Dr. Durrie, Phil Hoopes, Jr., MD, and Luke Rebenitsch, MD. Different surgical approaches such as pockets versus flaps also have their roles. For all these reasons, synthetic corneal inlays have made tremendous advances. They have also increased awareness of the corneal inlay space and sparked interest in other materials, such as human collagen, for use as an inlay or an onlay. Overall, advancements in the technologies are why so many patients and doctors are interested in various corneal inlays. I hope you find this issue of EyeWorld a quality step forward in your understanding of corneal inlay technology. EW Vance Thompson, MD, Refractive editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S March 2017 Volume 22 • No. 3 Publisher Donald Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Michelle Dalton Reading, Pennsylvania Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. 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