Eyeworld

91 EW FEATURE March 2017 • Advances in corneal inlays AT A GLANCE • Use of the contact lens test offers a realistic simulation of distance vision but is not always representative of near vision. • The contact lens test assumes an important role in determining corneal correction of presbyopia, especially in perfectionist patients. • A pristine distance correction in the dominant eye is of key importance. • Many of today's patients had their distance vision corrected when they were younger and now desire near vision correction. by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer to simulate the desired refraction. It can be a useful tool in refining a patient's visual needs and tolerance, according to Lance Kugler, MD, Truhlsen Eye Institute, University of Nebraska Medical Center, and Kugler Vision, Omaha, Nebraska. In an interview with EyeWorld, Dr. Kugler explained, "I think there is a role for the contact lens trial in the evalu- ation of corneal inlay patients, but I think we need to be careful. The multifocal contact lens test seems to offer a reasonable simulation of what distance vision is like once the inlays are in. But the contact lens test is not always as representative for near vision results. If a patient likes his vision with the multifocal contact lens, he is probably going to like his vision with the Raindrop inlay [ReVision Optics, Lake Forest, California]. But even if he doesn't like what vision is like with the contact lens trial, there is still about a 50% chance he'll like vision with the Raindrop, according to a recent trial." Experts reveal the right and the wrong patient criteria for corneal inlay implantation C orneal inlays are a new option for correcting pres- byopia and a hot topic. These intrastromal devices are additive, meaning they achieve the desired refraction without the removal of any corneal tissue. Choosing the right candidate for corneal inlays will determine the success of the procedure and ulti- mately the recipient's satisfaction. EyeWorld spoke with two leading corneal inlay advocates about their decision-making process. Contact lens test It is best if patients get a feel for what vision will be like with cor- neal inlays before taking the dive. A good way to do this is with a contact lens test, which is designed Dr. Kugler thinks that experi- enced refractive surgery practices are adept at evaluating individuals who can tolerate monovision or one- eye dominance for distance, and although most will try a contact lens trial, eye doctors won't solely rely on contact lens testing. It is a useful guideline, especially for physicians who are new to corneal inlays and monovision for individuals with dysfunctional lens syndrome (DLS) treatment, however, he feels that the test has a relatively low specificity and that surgeons need to take that into consideration. According to Vance Thompson, MD, Sanford University of South Dakota School of Medicine, and Vance Thompson Vision, Sioux Falls, South Dakota, the contact lens test is revealing in a few important ways. "We know that monovision creates the most blur at a distance, and if an individual can tolerate that blur, there is a high likelihood that he will be satisfied with corneal inlays. The contact lens test is a great simu- lation of the reduced image quality at distance and of near gain. I will try testing about 1 D of distance blur because that blurs distance more than a corneal inlay will and can also affect stereoacuity more than a corneal inlay. If the patient is reasonably comfortable with that, there is a good chance he or she will like the inlays. For near vision, it is important to allow the patient to see what it is like to have just one eye that can read and see how the near blur from the other eye feels. Patients should understand that one eye is blurry up close and the other has an image reduction at a distance, with both eyes open. I also like to emphasize the importance of night driving while doing the con- tact lens test, to fully understand the effects of monovision," he said. Patient choice When it comes to patient choice, Dr. Kugler had very clear guidelines. "What is great about corneal inlays is that they are the first dedicated technology that we have to address the plano presbyope, which is the last frontier in refractive surgery. We have always had good solutions for people with poor distance vision, but we have struggled for solutions for people with dysfunctional lens syndrome as to how we can help them see up close. I think that cor- neal inlays are an excellent option Choosing a corneal inlay candidate Raindrop inlay in the cornea continued on page 92

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