Vision Status: Presbyopic Patient Undergone Corneal Inlay Procedure / Jurnal Sains Kesihatan Malaysia

This study reports the vision status of a presbyopic patient who has undergone a corneal inlay procedure. The study hopes to provide optometrists more insight on the procedure and the co-management involved in such a patient. The patient, a 48 years-old Chinese woman with presbyopia underwent the corneal inlay procedure three years ago. She had the inlay implanted in the non-dominant eye to aid near vision i.e. her left eye. The pre and post-operative evaluations include distance and near visual acuity, fundoscopy, tonometry, Schirmer’s test, slit lamp evaluation, corneal topography and corneal pachymetry. Near visual acuity for the left eye improved from N14 to N5 immediately after the procedure. Even after 3 years of post-operative followup, the patient was still able to maintain her near vision. In conclusion, the corneal inlay procedure helped to improve near vision of this presbyopic patient. Optometrist plays a very important role in the co-management of such patients alongside with the ophthalmologist in terms of visual functional assessments pre and post-surgery, counseling of the procedure and managing patients’ expectations.

Comparison of Intracorneal Inlay for Presbyopia Correction: Hydrogel and Small-Aperture Inlays with a Six- Months Follow-Up

PURPOSE: To study the safety and efficacy of corneal reshaping and small-aperture inlays and compare the clinical results. METHODS: From February 2014 to November 2014, 22 corneal reshaping inlays were inserted at Asan Medical Center and from October 2012 to March 2013, 26 small-aperture inlay surgeries were performed: 6 eyes at Asan Medical Center and 20 eyes at Samsung Medical Center. The preoperative and postoperative parameters were reviewed retrospectively and included monocular uncorrected distance visual acuity (UDVA; log MAR), uncorrected near visual acuity (UNVA; log MAR), refraction and corneal curvature based on automated refractor keratometry, reading distance and patient satisfaction. RESULTS: In the hydrogel inlay group, preoperative mean monocular UNVA was 0.83 +/- 0.05 and monocular UDVA 0.07 +/- 0.03. At 6 months, mean monocular UNVA was 0.23 +/- 0.05 and UDVA 0.05 +/- 0.02. The most preferred mean reading distance in the hydrogel inlay group was 39.38 +/- 3.18 cm. In the small-aperture inlay group, preoperative mean monocular UNVA was 0.4 +/- 0.06 and monocular uncorrected visual acuity 0.27 +/- 0.04. At 6 months, mean monocular UNVA was 0.11 +/- 0.02 and UDVA 0.09 +/- 0.05 and the most preferred mean reading distance was 44.23 +/- 5.17 cm. Although 85% of patients in the corneal reshaping inlay group were satisfied or very satisfied, only 20% of patients in the small-aperture inlay group were satisfied. CONCLUSIONS: Both inlays are considered good options for correcting presbyopia. However, postoperative satisfaction score was higher and less glare symptoms were reported in the hydrogel inlay group.

Surgical treatment of presbyopia

Presbyopia is the progressive reduction in the ability to focus on near objects, and as an age-related condition, the prevalence of presbyopia is expected to increase with the aging of society. A number of corneal surgical procedures are available for the treatment of presbyopia, including monovision laser in situ keratomileusis (LASIK)/laser-assisted subepithelial keratomileusis (LASEK), conductive keratoplasty, presbyopic LASIK, and corneal inlay. Implantation of presbyopia-correcting intraocular lenses (IOLs), such as refractive/diffractive IOLs or accommodating IOLs, is also an option. Despite the variety of treatment options available, a perfect solution has yet to be developed and patients may present with visual or optical complications such as halos, glare, or decreased contrast sensitivity. As such, careful selection and customization of treatment is essential, based on patients' individual needs and requirements for vision.