Eyeworld

EW FEATURE 98 Advances in corneal inlays • March 2017 AT A GLANCE • More myopic patients tend to do well with a KAMRA inlay. • Low hyperopes tend to be set up better for a Raindrop. • Monovision contact lenses can sim- ulate either available corneal inlay. • Cataract surgery can be performed with an inlay in position. • Corneal inlay performance may improve following natural lens replacement. by Rich Daly EyeWorld Contributing Writer an uncoupling of the offset of spher- ical aberration between their lens and cornea. Jay Pepose, MD, PhD, director, Pepose Vision Institute, and professor of clinical ophthalmology, Washington University School of Medicine, St. Louis, considers LASIK with blended vision for suitable candidates after assessing corneal topography, pachymetry, and the ocular surface. Stage 1 patients also can now be treated with the KAMRA inlay (AcuFocus, Irvine, California), which is a small aperture implant placed in a lamellar pocket. The device works best implanted monocularly in –0.75 D eyes, whether with natural vision or after LASIK, Dr. Pepose said. In comparison, the Raindrop inlay (ReVision Optics, Lake Forest, California), which is placed directly under a LASIK-type flap, can help patients with good distance vision and up to 1 D of hyperopia. Among stage 1 patients consid- ering corneal inlays, William Wiley, MD, medical director, Cleveland Eye Clinic, Ohio, may try a multifocal or monovision contact lens, which provides similar optics to a Raindrop inlay. "That simulates nicely what Raindrop vision is," Dr. Wiley said. "Alternatively, we can demonstrate an aperture optic with a pinhole occluder in the office to simulate the optics of a KAMRA corneal inlay." Dr. Wiley discusses advantages and disadvantages of each option for patients, some of which depends on their baseline prescription. More myopic patients—in the range of –0.5 D or –0.75 D—tend to do well with a KAMRA inlay, Dr. Wiley said. "It seems that the KAMRA with aperture vision optics, takes good intermediate vision and extends the depth of focus to both distance and near," Dr. Wiley said. "So patients starting with mild myopia do well with the KAMRA inlay." If the patient is a low hyperope, he or she tends to set up better for a Raindrop. The "sweet spot" is some- where between +0.5 D and +0.75 D, Dr. Wiley said. The inlay works by steepening the cornea centrally, which not only treats some of the hyperopia but also brings in the near vision. "So often we lean toward the Raindrop in the low hyperopes," Dr. Wiley said. Wider range As discussed, the prime base range of corneal inlays is between -.75 (KAM- RA) and +.75 (Raindrop). Presbyopic patients with baseline prescriptions beyond these sweet spots may benefit from combined LASIK and corneal inlay. As such, LASIK can be used to bring the baseline position into the ideal range of performance for corneal inlays, Dr. Wiley said. Kevin Waltz, MD, president, Ophthalmic Research Consultants, said it's important to recognize inlay patients are usually between 45 and 55 and have some residual accom- modation—just not enough. "We're augmenting it, and the augmentation will last for a peri- od of time, just like when you do monovision," Dr. Waltz said. "If you Surgeons' experience with corneal inlays have shown which patients can benefit and how the devices interact with other treatments T he emerging presbyopia treatment of corneal inlays expands surgeons' options, but the technolo- gy can affect other vision treatments. Corneal inlays are one of a growing number of surgical options to address the deteriorating function of the crystalline lens over time, known as dysfunctional lens syn- drome (DLS). LASIK monovision is the tradi- tional treatment for many patients with stage 1 DLS, which for many patients is not only presbyopia but Roles vary for inlays among presbyopia treatments Microscope view of KAMRA inlay in an eye with a posterior subcapsular cataract Cataract removed with phaco under the inlay Side view of an inlay as a diamond blade corneal incision is created

• Blank Page
• Blank Page (1)