March 2016

 

COVER FEATURE

 

Intracorneal inlays

Correcting presbyopia with corneal inlays


by EyeWorld staff

 
 

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Many patients read well from day 1, but some require a month or more of healing and neuroadaptation. I counsel patients that their vision will continue to improve for 3 to 6 months. Richard Lindstrom, MD

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Figure 1. Ophthalmologists were asked, Overall, how satisfied are your corneal inlay patients with their outcomes at near at 1-year postop?

Figure 2. Ophthalmologists were asked, Overall, how satisfied are your corneal inlay patients with their outcomes at intermediate at 1-year postop?

Figure 3. Ophthalmologists were asked, Overall, how satisfied are your corneal inlay patients with their outcomes at distance at 1-year postop?

ASCRS members weigh in

Corneal inlays are one of the newest options for correcting presbyopia. Their main advantage is that they are additive and do not require the removal of any tissue, so the effects are reversible.

There are currently three corneal inlays in various stages of development: the Flexivue Microlens (Presbia, Dublin), the Raindrop (ReVision Optics, Lake Forest, Calif.), and the KAMRA (AcuFocus, Irvine, Calif.), which was recently approved by the FDA. All are implanted in the nondominant eye.

In the 2015 ASCRS Clinical Survey, ASCRS members were surveyed about their experience with corneal inlays. Here are the results.

Ophthalmologists were asked, Overall, how satisfied are your corneal inlay patients with their outcomes at near, intermediate, and distance at 1-year postop? Approximately two-thirds of surgeons reported that their patients are very or somewhat satisfied with their near (67%), intermediate (65%), and distance (67%) vision. At all distances, non-U.S. ophthalmologists were more likely to believe that corneal inlay patients are very or somewhat satisfied with their vision (8% to 20% higher than U.S. physicians). See Figures 1, 2, and 3.

According to Richard Lindstrom, MD, Minneapolis, the patient satisfaction rates in the clinical trials were similar to those reported for LASIK, refractive lens exchange, and phakic IOLs. The satisfaction rate shown in this survey is similar to the level of satisfaction reported in the literature with monovision. Approximately 2% of patients will request a corneal inlay removal, and a few require a recentration procedure or a PRK enhancement to achieve the best outcome, he said.

When asked how satisfied their corneal inlay patients are with their night vision and overall vision at 1 year, 61% of ophthalmologists said that their patients are very or somewhat satisfied with their night vision, and 70% of ophthalmologists said that their patients are very or somewhat satisfied with their overall vision.

According to Dr. Lindstrom, there are some pearls for achieving good visual outcomes with corneal inlays. This procedure, like all others, requires careful attention to detail preoperatively, intraoperatively, and postoperatively. Preoperatively, a healthy ocular surface is critical. Of course, it is important to rule out ectasia, have adequate corneal thickness, and the proper refractive error with minimal astigmatism and higher order aberrations. Intraoperatively, the pocket depth should be between 200 m and 300 m, with a fine raster pattern to create a smooth bed, 6 x 6 or tighter. The inlay must be well centered, and the AcuTarget HD [AcuFocus] helps here. Postoperatively, ocular surface management is again critical. Potential side effects include interface haze, a decentered inlay, diffuse lamellar keratitis, and infection. Many patients read well from day 1, but some require a month or more of healing and neuroadaptation. I counsel patients that their vision will continue to improve for 3 to 6 months, he said.

Editors note: Dr. Lindstrom has financial interests with Abbott Medical Optics (Abbott Park, Ill.), AcuFocus, Alcon (Fort Worth, Texas), and Bausch + Lomb (Bridgewater, N.J.).

Contact information

Lindstrom: rllindstrom@mneye.com

Related articles:

Future of noninvasive presbyopia treatment by Liz Hillman EyeWorld Staff Writer

New generation of IOLs to correct presbyopia by Louise Gagnon EyeWorld Contributing Writer

PresbyLASIK for presbyopia correction by Matt Young and Gloria D. Gamat EyeWorld Contributing Writers

Options for presbyopia correction by Ellen Stodola EyeWorld Staff Writer

Presbyopia solutions on the horizon by Kerry D. Solomon, MD, refractive editor

Correcting presbyopia: Corneal inlays Correcting presbyopia: Corneal inlays
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