Eyeworld

EW FEATURE 94 byline goes here plus fade AT A GLANCE • text goes here. • text goes here. • text goes here. either do nothing and wait for lens replacement or do an early lens re- placement. With the high standards achieved with modern day multifo- cals, it is important to offer patients that option and understand lentic- ular status before advising them to proceed with a corneal correction of presbyopia," Dr. Thompson said. He spoke about the sustainabil- ity of corneal inlay monovision as compared to LASIK or PRK mono- vision as being an attractive feature for patients and an incentive for inlay correction. "In my research, I found that the effect of the inlay helping near vision did not wear off nearly as quickly as with PRK or LASIK monovision. The idea of this long-lasting effect getting them through their 50s and 60s is very attractive to presbyopic patients. If they are developing any evidence of haze or they are not satisfied by 4 to 6 months postoperatively, I would typically recommend removal of the inlay. If they are healing well, their best corrected image quality is good, but their residual refractive error is affecting their visual joy, then we talk about laser enhancement," Dr. Thompson said. EW Editors' note: Drs. Kugler and Thomp- son have financial interests with AcuFocus. Contact information Kugler: lkugler@kuglervision.com Thompson: vance.thompson@ vancethompsonvision.com combination of an inlay with a slight near target tends to be a very good solution," Dr. Kugler said. Previous surgery Patients who have had previous refractive surgery are an ever-grow- ing demographic. For decades the average age of LASIK patients has been 38 years, which now, some 20 years on, places these individuals in the midst of presbyopic eye changes. According to Dr. Kugler, "There is a tsunami of patients out there who had their distance vision corrected when they were younger and who now desire a near vision correction. With corneal inlays, we have an avenue to reach out to these patients who are now reaching DLS and offer them a solution. The KAMRA inlay [AcuFocus, Irvine, California] lends itself well to post-LASIK patients, assuming they have enough corneal stroma remaining." Dr. Thompson indicated that in post-PRK or LASIK patients, it all comes down to corneal thickness. "One thing we know about corne- al inlays is that we need a healthy bridge of tissue over the inlay. The other issue is their lenticular status, which is why I like measuring the optical scatter index to ensure a clean optical system, meaning the cornea, lens, vitreous, and tear film are not affecting their image quality. If I diagnose that they have reduced image quality from early lens chang- es, then an inlay, PRK, or LASIK monovision is not in their best interests, and their best option is to Choosing continued from page 92 " In 2017 our definition of near vision is very different from what our definition of near vision was 20 or 30 years ago. People are using computers, cell phones, and tablets at a different distance than they once needed to see the things they were looking at up close. " —Lance Kugler, MD

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