William F. Wiley
CHICAGO — Nearly every presbyopic LASIK patient can be a candidate for corneal inlays, and outcomes depend on proper adjustment, deep implantation, and pre- and postoperative management of the ocular surface, according to a speaker here.
LASIK is the perfect tool to bring patients to the refractive “sweet spot” of –0.75 D, William F. Wiley, MD, said at the Refractive Surgery Subspecialty Day preceding the American Academy of Ophthalmology annual meeting.
“Typically, we target the distance eye for plano. We leave the nondominant eye to about –0.75 D, and at the same time we’re doing refractive surgery we’re also implanting the corneal inlay through a pocket underneath the LASIK flap,” he said.
Adjusting the corneal inlay to achieve the proper refractive target is a key step in the procedure, he said.
“Doing a corneal inlay without adjustment for that proper target is analogous to doing a premium lens without correcting astigmatism. It’s very important for these inlays to work that you have to hit that refractive target,” he said.
Inlays are not for just a “niche market,” Wiley said. In 2016-2017 at his practice, 268 patients were implanted with corneal inlays, whereas 182 presbyopic patients were implanted with IOLs.
Despite an FDA warning in regard to the Raindrop inlay (ReVision Optics) and its potential to cause haze in patients 5 years postoperatively, Wiley noted he had implanted the Kamra inlay (AcuFocus) in 353 patients, with only two patients reporting haze due to implantation at a shallow depth.
“There is a difference where you place them,” he said. “Definitely implanting the corneal inlay at greater than 40% depth decreases the haze formation.”
Optimizing the ocular surface preoperatively and managing the surface postoperatively can also improve outcomes, he said. – by Robert Linnehan
Reference: Wiley WF. Advances in corneal inlays for presbyopia. Presented at: AAO Subspecialty Day; Oct. 26-27, 2018; Chicago.
Disclosure: Wiley reports he is a consultant for CorneaGen and Revision Optics, and is an investigator for Presbia.