Clinicians coming to terms with dysfunctional lens syndrome
Stages a new way to discuss presbyopia, cataract progression, treatment options
Two corneal inlays are currently available in the United States (Kamra, AcuFocus; Raindrop, ReVision Optics). The former is polyvinylidene fluoride ring placed intrasomally in the cornea of the nondominant eye, with its small aperture expanding depth of focus. In contrast to conventional LASIK and PRK, the inlay does not diminish distance vision, which remains binocular.
“The [inlay] has been very popular,” said Dr. Durrie, who was a clinical investigator for the device and has been implanting it for 10 years. “I select patients that have good distance vision, no astigmatism, and healthy eyes. It works very well.”
The other inlay, an hydrogel implant, provides multifocal refraction. The strongest curvature is in the central region, providing near vision. The curvature gradually decreases toward the periphery, creating regions that provide intermediate and distance vision.
More corneal inlays are under development, and “if they get approval, we will be able to pick different ones for different patients,” he said, adding that no head-to-head trials have yet compared these inlays or either one to any of those still in the pipeline.
“Over the next 5 years, we’ll find out which patients are best for which procedures,” he said.
The inlays offer one significant advantage over IOL implants: they can be removed, making the procedure reversible.
Patients who are more than 3 D hyperopic may benefit from lens replacement even if they are in stage 1, he said.
“That’s the best procedure for these patients because it stops progression to stage 2 and stage 3,” he said. “A lot of people are going for that option because they can.”
Lens replacement is also the best option for someone who has progressed to stage 2 or 3, Dr. Durrie said. To educate patients about these options, Dr. Durrie often uses material from companies that provide inlays and laser surgery.
“With this new way to talk to patients, the industry is now responding with brochures and videos for dysfunctional lens syndrome education,” he said.
New diagnostic equipment helps, he says, especially the HD analyzer.
“It measures ocular scatter so it shows that if there is loss of quality,” he said. “It’s very easy to do. We use it on every patient in every exam.”
Dr. Durrie uses the results to show patients how light is being scattered from their lenses. He also listed the Pentacam (Oculus), Galilei (Ziemer Ophthalmic Systems) and the iTrace (Tracey Technologies) as useful devices.
“We do photos of lens to help educate patients,” Dr. Durrie said. “Lots of doctors are modifying the way they do exams so they can better educate patients.”
Optometrists are also finding it helpful to talk about dysfunctional lens syndrome, he said.
“Optometric groups are very enthusiastic about this,” he added, “because they can do a better job educating their patients and making sure they understand why a new pair of glasses isn’t going to help.”