Eyeworld

EW FEATURE 88 Advances in corneal inlays • March 2017 Drs. Chu and Whitman have finan- cial interests with ReVision Optics. Dr. Manche has no financial interests related to his comments. Contact information Chu: yrchu@chuvision.com Durrie: ddurrie@durrievision.com Lindstrom: rllindstrom@mneye.com Manche: edward.manche@stanford.edu Whitman: whitman@keywhitman.com based on current volume of proce- dures and experience we have, that we're going to continue doing the KAMRA for now, but that doesn't mean we would never want to get trained in the Raindrop or Flexivue in the future. "The bottom line is it's too soon to know how this is going to sort out. The good news is we have two good choices of something we never had before and within a year or two we'll have a third good choice," Dr. Lindstrom said. Invigorating ophthalmology While the inlays are beginning to serve a previously untapped market, they're also reinvigorating ophthal- mologists and their practices. "Inlays not only are great new technologies, but I think they're firing up surgeons again to start thinking about how they can take care of these patients," Dr. Durrie said. "Sometimes practices need a new technology, like an inlay, to get them fired up to start doing promo- tions, seminars, Facebook Live, and other things to get the word out that patients should come in and talk to their doctor if they're having these issues." Even if the patient comes in the door and is not a candidate for an inlay, Dr. Durrie said he or she might be a candidate for another procedure to improve vision. "These people are coming in for the inlay, but some are not great candidates. Still, you can talk to them about what they are a great candidate for. That's why we've seen this real interest in practice growth," Dr. Durrie said. EW References 1. Barraquer JI. Queratoplastia Refractiva. Estudios e Informaciones Oftalmológicas. 1949;10:2–21. 2. Barraquer JI. Modification of refraction by means of intracorneal inclusions. Int Ophthal- mol Clin. 1966;6:53–78. 3. Steinert RF, et al. Hydrogel intracorneal lenses in aphakic eyes. Arch Ophthalmol. 1996;114:135–41. 4. AcuFocus. Ophthalmic Devices Panel Exec- utive Summary. FDA. 2014. Accessed Jan. 9, 2017. www.fda.gov/downloads/AdvisoryCom- mittees/CommitteesMeetingMaterials/Medi- calDevices/MedicalDevicesAdvisoryCommit- tee/OphthalmicDevicesPanel/UCM399644.pdf 5. ReVision Optics. Summary of Safety and Effectiveness Data. FDA. 2016. Accessed Jan. 9, 2017. www.accessdata.fda.gov/cdrh_docs/ pdf15/P150034b.pdf Editors' note: Dr. Lindstrom has finan- cial interests with AcuFocus. Dr. Durrie has financial interests with AcuFocus, Alcon (Fort Worth, Texas), and Abbott Medical Optics (Abbott Park, Illinois). 412 study participants in the pivotal study had completed 6-month post- op visits. The company said that by the fourth quarter of 2017, it expects to have 24-month postop data on 300 patients to submit its premarket approval module to the FDA. In August 2016, Presbia acquired Neoptics (Hünenberg, Switzerland), integrating intellectual property and know-how from the latter compa- ny's Icolens—a bifocal, hydrogel (2-hydroxyethyl methacrylate and methyl methacrylate) implant—into the Flexivue Microlens. What inlays bring to the market "Everybody gets presbyopia and nobody loves presbyopia," Dr. Whitman said. "Here's a disease that affects everyone, so there is a huge market out there in a patient seg- ment that should be able to afford it." Until the recent approval of intracorneal inlays, the only surgical option for presbyopia was monovi- sion or multifocal IOLs at the time of cataract surgery. These implants offer freedom from readers (though there will be situations where they may still be needed) without compromising distance vision and without having to wait for a cataract to develop. What's more, they can be removed if the outcome is not positive. With two FDA-approved inlays on the market and a third expect- ed, ophthalmologists differ in their opinions as to how they'll be adopted. Some think physicians will train in all inlay types, giving them the ability to choose the best inlay for each patient's situation. Others, however, think surgeons will choose to specialize in one and will use PRK or LASIK to tailor the patient to the inlay. Dr. Lindstrom said while it might start with physicians choos- ing to work with a specific inlay, he thinks surgeons will eventually add more options. "It's a bit like if you look at presbyopia-correcting lenses," Dr. Lindstrom said, noting that oph- thalmologists use different types of multifocal IOLs depending on the patient. "I think this will be the same. … My group has decided, History continued from page 87 An early generation Presbia-style hydrogel implant placed by Dr. Lindstrom in 1987. The patient is still doing well 30 years later with 20/25 at distance and J2 at near. A patient of Dr. Lindstrom's with an AcuFocus KAMRA inlay placed in 2015. The patient's vision is 20/25, J1, and stable. Source (all): Richard Lindstrom, MD

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