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    Micro-thin prescription inserts an option for keratoconus

    Simple procedure helps reduce higher-order aberrations, allowing patients to see better

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    Editor's Note: Addition Technology Inc., the manufacturer of Intacs micro-thin prescription inserts for surgical vision correction, announced Aug. 4 that it had received approval from the FDA for a Humanitarian Device Exemption to market the inserts for the treatment of keratoconus. Dr. Rabinowitz's presentation was given earlier this year at the American Society of Cataract and Refractive Surgery meeting.

    San Diego—Micro-thin prescription inserts (Intacs, Addi- tion Technology Inc.) can be successfully used to treat patients with keratoconus em- ploying the IntraLase femtosecond laser (IntraLase Corp.), reported Yaron S. Rabinowitz, MD, during the American Society of Cataract and Refractive Surgery annual meeting.


    Yaron S. Rabinowitz, MD. Phone: 310/423-9640. E-mail: [email protected] Dr. Rabinowitz has no financial interest in IntraLase or Addition Technology. He has received travel support from Addition Technology.
    In a small comparative study of this off-label use of the micro-thin prescription inserts, patients who received the inserts after IntraLase creation of the channels had refractive outcomes similar to patients who received the inserts with mechanically made channels, according to Dr. Rabinowitz, director of ophthalmology research, Cedars-Sinai Medical Center, Los Angeles, and clinical professor of ophthalmology, University of California-Los Angeles School of Medicine.

    Dr. Rabinowitz completed 12 cases with the channels created mechanically and then another 12 after obtaining the IntraLase laser. He found postoperative uncorrected visual acuity (UCVA) to be similar in each group, achieving a mean improvement of three lines. Best-corrected visual acuity (BCVA) postoperatively was slightly better in the IntraLase group, which achieved a mean improvement of 3.4 lines. The group with mechanically created channels had a mean improvement of only 2.4 lines of BCVA, he noted.


    Figure 1 Preoperative corneal topography of 40-year-old male with a best spectacle-corrected visual acuity of 20/70.
    Improvement in sphere postoperatively was slightly better in the group with mechanically created channels than the IntraLase group, with a mean change of 3 D in sphere versus a mean change of 2.17 D in sphere, respectively. The same was true for astigmatism postoperatively, with a mean change of 1.43 D in the mechanical group versus a mean change of 1.22 D in the IntraLase group, Dr. Rabinowitz said.

    "The primary goal is to make the patients who are contact lens-intolerant, contact lens-tolerant and to prevent the need for a corneal transplant," Dr. Rabinowitz said.


    Figure 2 Postoperative corneal topography after placement of a single micro-thin prescription insert placed in the steepest part of the cone.
    "In terms of contact lens tolerance, 90% of my patients who underwent IntraLase treatment (to create the channels for the prescription inserts) were contact lens or glasses-tolerant versus 75% of the chanical group," he said.

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