Eyeworld Daily News

EW SHOW DAILY 14 ASCRS News Today Sunday, May 7, 2017 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Update on presbyopia ticity with age. However, the proof of successful presbyopia "correction" is ultimately in the results. Dr. LiVecchi explained that one of the more interesting and prom- ising surgical approaches to presby- opia is the use of corneal implants. The KAMRA inlay (AcuFocus, Irvine, California) is a 3.8 mm diameter disc with a 1.6 mm pinhole aperture, which is implanted into the cornea of the non-dominant eye for near vi- sion. The dominant eye is not oper- ated on to maintain distance vision. The pinhole allows only focused light to enter the eye, so working together, an individual's eyes can see both near and far. Dr. LiVecchi pointed out that this correction was not the same as monovision, which corrects one eye for near and one for far, and may not last over time. Inlays provide a solution for near and far vision, allow binocular vision, are safe, reversible (which appeals to many patients), and can be combined with other types of refractive surgery. Some disadvantag- es include glare, haloes, night vision disturbances, and in some cases a loss of contrast sensitivity. Dr. LiVecchi explained that 80% of doctors do not use inlays, that they are his "most expensive proce- dure," and that patient satisfaction is roughly 40%. Nonetheless, he thinks that the KAMRA inlay offers a unique possibility to bridge the gap between LASIK and cataract surgery. However, as things stand, the most popular choices among surgeons for presbyopic correction are laser vision correction and multifocal IOLs. EW Editors' note: Dr. LiVecchi has no financial interests related to his comments. I t's no secret that presbyopia is the final frontier in eye surgery, according to John LiVecchi, MD, Orlando, Florida, who spoke at the Technicians & Nurses Presbyopia Update session. This "holy grail" represents the final obstacle that surgeons need to clear to provide an ever-aging population with excellent near, intermediate, and distance vision. Dr. LiVecchi thinks that as innovations progress, the answer to presbyopia will come into reach. Presbyopia, the progressive loss of accommodation, is complete by the time most of us turn 50 years of age, leaving us with "zero" accom- modative ability. It is "inevitable, dramatic, and frustrating," he said. With 12% of the world's population currently over 60 years of age, the prediction is that 2 billion people will be presbyopic by 2020. The challenge is finding the best approach to take. Surgeons can choose between surgical (pseu- doaccommodative) or dynamic approaches to the problem. Surgical procedures include presbyLASIK, LASIK, LASEK, PRK, monovision, corneal implants, and multifocal IOLs, while dynamic solutions in- clude procedures such as accommo- dative IOLs, lens filling optics, femto lens softening, and scleral proce- dures like incisions and bands. The choice may depend on the accommodative theory that makes more sense to you. Dr. LiVecchi is an advocate of Schachar's idea that says that ciliary muscle contraction increases tension on the zonules, resulting in equatorial stretching that causes the lens to change shape, leading to accommodation. In contrast, Helmholtz proposed that the zonules relax during accommo- dation, with presbyopia ultimately resulting from the loss of lens elas- Dr. LiVecchi updates attendees on "Presbyopia, the final frontier."

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