Eyeworld

EW FEATURE 90 byline goes here plus fade AT A GLANCE • text goes here. • text goes here. • text goes here. be another drawback, Dr. Gatinel said. This could be linked with interferences with corneal metabo- lism and dry eye-induced symptoms. Suboptimal results usually trace back to inappropriate patient selection, Dr. Gatinel said. "Low myopes should be regarded with caution, as no multifocal or extended depth of focus correction method can provide the crisp vision that these patients have without their distance correc- tion," he said. Inlays also do not stop the onset of progressive lenticular dysfunc- tion and opacity, Dr. Pepose said. "Small-aperture inlays may be more immune to the effects of progressive presbyopia, as their mechanism of action involves blocking unfocused peripheral light rather than the induction of dioptric change or neg- ative spherical aberration," he said. Although there is a risk for damage that occurs after flap creation—something needed for inlay insertion—those risks and the ways to fix them are familiar to refractive surgeons, Dr. Vukich said. "We are very comfortable with the techniques so these problems are unusual and when they do occur, we can handle them," he said. EW Editors' note: Dr. Vukich has financial interests with AcuFocus. Dr. Pepose has financial interests with AcuFocus and Abbott Medical Optics (Abbott Park, Il- linois). Drs. Gatinel and Maloney have no financial interests related to their comments in this article. Contact information Gatinel: gatintel@gmail.com Maloney: rm@maloneyvision.com Pepose: jpepose@peposevision.com Vukich: javukich@gmail.com patients implanted with the KAM- RA, and it did not make the surgery difficult," Dr. Gatinel said. "The target refraction should be planned to be slightly myopic (–0.75 D) for small-aperture inlays." Dr. Vukich has seen patients with inlays who go on to receive a monofocal IOL and retain a near visual acuity benefit. The inlays also have not hampered the ability to perform cataract surgery. "The ability to enjoy the near benefit and maintain that through the years in which cataract development is likely and after cataract surgery, maintain that ability is another distinct ad- vantage," he said. Potential drawbacks As with any surgical procedure, inlays come with certain risks, including corneal haze, glare, and a drop in best-corrected visual acuity, Dr. Maloney said. However, the haze does not seem to have much effect on vision, he added. "There's no such thing as a surgery with a zero complication rate. We know that individuals with significant dryness in their eyes can have a diminished effect," Dr. Vukich said. Inlays also require some ex- tra preoperative planning and follow-up, Dr. Gatinel said. For instance, surgeons and their staff may spend extra time explaining to patients what inlays are, as some are reluctant to have what they think will be a "foreign body" in their eyes. "Some patients think of it as a relatively bulky or electronic device, and it's important to dissipate such misconceptions," he said. Sometimes, patients have a hard time tolerating inlays, and that can Weighing continued from page 89 " Generally, if the patient is unhappy 3 months after inlay insertion, more time won't make him or her happy. That is a good time to remove the inlay. " —Damien Gatinel, MD, PhD

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