Surgery must be an option
Moving from the top of the cornea to in the eye is that much easier when your management of the patient is on a continuum. When we detail to our patients that they are ametropic and need correction, we do not give them one choice. Instead, we lay out the options and communicate our recommendations.
Surgery should be in that discussion as well. LASIK can provide a monovision or even multifocal result; however, this option needs a previous refractive error. In the last year we have advanced our ability to accommodate patients with little to no correction.
Kamra corneal inlay started the ball rolling with the pocket procedure, utilizing an increased depth of focus for near tasks. In 2016 ReVision Optics received FDA approval for Raindrop, a near vision corneal inlay. Both Kamra and Raindrop are a monocular surgery, not invasive, and can be used for patients who are emmetropic but dysfunctional at near.
The management of these patients is no different than any other presbyopic patients we counsel.
IOLs in play
Presbyopia is a continuous process, and thus managing the expectations and eventual lenticular changes is necessary. Moreover, because your practice has been an active participant in your patients’ close vision demise, you are prepared and excited for the cataract.
Removing DLS and providing the patient with a shiny new lens—like Tecnis Symfony IOL from Abbott Medical Optics with its extended depth of focus or AcrySof IQ ReSTOR +3.00 D Multifocal Toric IOL from Alcon—is better than getting an upgrade on your smartphone.
The new lens in the eye will not become obsolete in a few weeks; it will do all the things the old one could—but better and not wear out.
The year 2020 is right around the corner. If I could develop one product to be a game changer, like the Apple iPhone that is celebrating its 10-year birthday, it would be presbyopia correction.
We have three years to start managing our patients with some great technology, but by 2020 this technology may all be old school—like 20(/)15 at near.