Eyeworld

95 EW FEATURE March 2017 • Advances in corneal inlays AT A GLANCE • Patients should be tested to see if they can accept monocular reading in their non-dominant eye before receiving an inlay. • Testing light scatter can help pin- point which patients can succeed. • Evaluating and managing the tear film is essential. by Maxine Lipner EyeWorld Senior Contributing Writer the inlay is placed in the non-dom- inant eye and patients can only accept reading with their dominant one, they may not feel like they have functional reading. "That's something we can test for ahead of time by showing them reading with monovision," he said. "With the inlay, they still have distance vision in both eyes so it's easier for them to accept that kind of monovision, but they need to be able to read with just one eye." Dr. Foster stressed the impor- tance of discussing with patients the potential night symptomatology with the inlay such as glare and halos. Physicians should also ensure that they don't have an occupation that precludes any form of monovi- sion. "I think the main issue is find- ing a way to demonstrate to them as closely as you can what their vision would be like," Dr. Foster said. For example, the pinhole process makes reading very accessible and com- fortable, but the letters aren't in a perfect focus. As part of the education process, Dr. Durrie recommends talking to patients about dysfunctional lens syndrome, which can be clearer to them than the term presbyopia. The term dysfunctional lens syndrome has become popular because it pegs the lens as the problem, he ex- plained. "I've always found that it's worthwhile to tell patients about the whole process: In their 40s the lens is going to be clear and colorless, but in stage 1 of dysfunctional lens syndrome, the lens loses its elasticity and the muscles can't bend it any- more and they start picking up read- ing glasses," Dr. Durrie said. "Stage 2 is in their 50s and 60s, and that's Strategies for predicting success T he two corneal inlays now available in the U.S. are making inroads at many practitioners' offices. But these are not for everyone. Here are some testing strategies that will help practitioners best predict who is likely to thrive with the procedure. Attaining success from the start is paramount, according to Daniel Durrie, MD, clinical professor of ophthalmology, Kansas Medical Center, and founder, Durrie Vision, Overland Park, Kansas. "When you're introducing a new procedure into your practice, you want your first 10 to 20 cases to go extremely well because your staff is looking over your shoulder and your part- ners are saying, 'Is it worthwhile getting involved in this?'" Dr. Durrie said. "You want to pick your patients with the best chance of success right from the beginning." Testing corneal inlays The small-aperture KAMRA inlay, a surgical option for the treatment of presbyopia continued on page 96 Education process Both the KAMRA (AcuFocus, Irvine, California) and the Raindrop (ReVi- sion Optics, Lake Forest, California) have been through the U.S. Food and Drug Administration (FDA) approval process, Dr. Durrie said, adding that there was important information gleaned from the data. "We know from the clinical data that the people who are slightly hyperopic are the best candidates for the Raindrop inlay, and the people who are slightly myopic in their non-dominant eye are the best candidates for the KAMRA inlay," Dr. Durrie said. "So we have a differ- entiation right from the beginning depending on where the patient's refractive status is." If patients have had previous LASIK or are planning on having LASIK in combination with an inlay, practitioners should carefully measure them and adjust the refractive error to make it ideal for the inlay, he said. If they're going to undergo combination surgery, they need to be an excellent candi- date for the procedures. Likewise, Gary Foster, MD, medical director, Eye Laser Center of Northern Colorado, Fort Collins, Colorado, stressed the importance of testing patients and educating them to ensure that they are well-suited for an inlay. "I think proper patient selection and education is para- mount with the inlay and similar to the education required with a multi- ple focus lens," Dr. Foster said. With any of the available inlays, there are significant benefits but also certain compromises that must be accepted in order to receive those benefits, he pointed out, adding that it's import- ant that patients clearly understand the tradeoffs so they can make an informed decision. "That increases the chances that they'll be happy with the result that they receive afterward," Dr. Foster said. One of the most important pieces of testing and education for the inlays, which are traditionally placed monocularly, is to find out whether the patient can read with one eye. "Some are wired in a fash- ion where they aren't able to accept that," Dr. Foster said, adding that if

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