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    Managing presbyopia with evolving inlay technology

    New presbyopic inlay offers ODs more options when treating presbyopes

    Innovation does not cease and nor should our ability to stay abreast of the latest surgical options for our patients. In past departments I have written about evolutionary options our patients have for presbyopia management. The ever-growing population of presbyopes is endless, and the desire to rid oneself of spectacles is unquenchable.

    The myriad of options has been detailed in Optometry Times, and those who have sought refractive surgical options in the past are great candidates today. The latest option available is the Raindrop Near Vision Inlay (ReVision Optics). While this inlay is hard to detect in the cornea, management should not be a challenge.

    The ideal Raindrop patient is slightly hyperopic with a range of +1.00 D to -0.50 DS, and less than or equal 0.75 DS cylinder. The eye must be healthy, with no previous refractive surgery and normal corneal and anterior segment. Most importantly, the patient must have a disposition that will be conducive to monocular surgery.

    Previously from Dr. Bloomenstein: Intense pulsed light bridges eye care and aesthetics

    Pre-operative preparation

    Pre-operative management for Raindrop is straight out of the optometric playbook—control the inflammation and allow for a healthy tear film. Patients who have irregular topography, thinner corneas, ectactic disease, or uncontrolled retinal disease are contraindicated for the inlay—dry eye should be controlled and not prohibitive.

    In the initial pre-operative phase, emphasize the importance of retaining homeostasis of the tears and the patient’s ability to neuro-adapt to this presbyopic correction. A trial lens with a multifocal contact lens in the non-dominant eye—often left in the eye up to a week—can simulate the near-to-distance adaption.

    You should be prepared for the post-operative journey now that your patient is ready for this 2-mm diameter, 30-micron thin inlay. Raindrop has the same water content and refractive index as the cornea.1 Controlling inflammation and continuance of homeostasis is the critical action in the procedure’s success.

    Most surgeons will use a regimen of an antibiotic for a week, a steroid such as Durezol (difluprednate, Alcon) for a month, artificial tears frequently, and the addition of a tear medication such as cyclosporine (Restasis, Allergan) or lifitegrast (Xiidra, Shire) in the presence of any keratoconjunctivitis sicca. The steroid is continued for two to three months. The follow-up schedule is left to the doctor’s discretion because outcomes will dictate the importance.

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    Optometry Times A/V