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Intracorneal Inlays for Presbyopia

Insructional Course 59 19/9/2011. Intracorneal Inlays for Presbyopia. Moderator Ioannis Pallikaris Instructors Stephen Slade John Vukich Dimitrios Bouzoukis. KAMRA (Formerly ACI 7000) (Acufocus). VUE+ (Formerly Presbylens) (ReVision). FLEXIVUE MICRO-LENS (Presbia).

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Intracorneal Inlays for Presbyopia

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  1. Insructional Course 59 19/9/2011 Intracorneal Inlays for Presbyopia Moderator Ioannis Pallikaris Instructors Stephen Slade John Vukich Dimitrios Bouzoukis

  2. KAMRA (Formerly ACI 7000) (Acufocus) VUE+ (Formerly Presbylens) (ReVision) FLEXIVUE MICRO-LENS (Presbia)

  3. INLAYS CHARACHTERISTICS

  4. Slit Lamp KAMRA CORNEAL INLAY (ACUFOCUS)

  5. KAMRA Corneal Inlay 3.8mm Diameter - 5 Microns Thick - 1/10th the Thickness of a Sheet of Paper (7.5 mm radius), and Flexible enough to Bend to Different Curvatures without Buckling Mass is 71-142 Micrograms - about the Weight of a Salt Crystal 5 microns AcuFocus Corneal Inlay in profile. KAMRA Inlay

  6. Inlay Design 8,400 micro-perforations(5-11µ) Pseudo-random pattern Maximize nutrient flow Minimize visual symptoms KAMRA Inlay

  7. Optical Principals of Inlay Light Rays Pass through the Small Aperture Over a Small Angle, Increasing the Depth of Focus Distance Vision is Minimally Affected 3.8mm diameter 1.6mm f22 KAMRA Inlay

  8. Surgical Procedure Pocket Flap KAMRA Inlay

  9. VUE+ CORNEAL INLAY (ReVision)

  10. Optical Principals of Inlay Light Rays Pass through the Small Aperture Over a Small Angle, Increasing the Depth of Focus Distance Vision is Minimally Affected Inlay Design 3.8mm diameter 1.6mm f22 VUE+ Inlay

  11. Presbyopic Corneal MicroLens • 2 mm diameter, ~30 μm thickness Product Overview • Hydrogel corneal microlens implanted after creating a femtosecond flap • Restores near and intermediate vision in patients with myopic, hyperopic, and emmetropic presbyopia • Transparent, biocompatible and mimics a healthy cornea • Removal with reversible vision 11 VUE+ Inlay

  12. How It Works Stromal Cushion 100 µm Bowman’s Layer Inlay Thickness 30 µm Flap Bed • Inlay has same refractive index as cornea but increases curvature in the center of the pupil 12 VUE+ Inlay

  13. Optical Design 1 Near 2 Intermediate 3 Distance 1 2 3 3 2 Refraction map (from Tracey wavefront data) 1 1 2 3 Corneal Cross-section Average radial refraction (Tracey) FLEXIVUE MICRO-LENS CORNEAL INLAY (PRESBIA)

  14. Inlay Design Thickness: 20μm Diameter: 3mm Peripheral zone with refractive power: +1,25D to +3,00D Central zone without refractive power FLEXIVUE MICRO-LENS Inlay

  15. Inlay Characteristics • Acts changing the refractive index of the cornea • Donut shape bifocal refractive power • The lens is implanted into the stroma of the cornea on the non-dominant eye, inside a corneal tunnel created using femtosecond laser. • The lens is “Invisible” • Biocompatible hydrophilic material with a central hole to increase more the nutrient flow. • The refractive effect is pupil depended, inreasing during near vision and decreasing during far vision, changing less the far vision in the operated eye than in a classic monovision procedure FLEXIVUE MICRO-LENS Inlay

  16. The concept of “Smart Monovision” There is a central myopic effect only when we analyze the 3,5mm zone. FLEXIVUE MICRO-LENS Inlay 3 months Post – Inlay Preop 3.5 mm Higher Order Aberrations Higher Order Aberrations Seidel Sphere -0.34 Cylinder -0.50 X 160 Seidel Sphere -2.05 Cylinder -0.50 X 174 Near Higher Order Aberrations Higher Order Aberrations 5.0 mm Far Seidel Sphere -0.54 Cylinder -0.26 X 167 Seidel Sphere -0.75 Cylinder -0.36 X 161

  17. iTrace wavefront analysis UDVA: 20/25, J1 Slit lamp photo and eye image taken from the iTrace. Inlay centered on visual axis-coincides with pupil center Refractive map of total ocular aberrations in the area of the inlay. The inlay’s peripheral part creates a myopic effect whilst the central part remains emmetropic FLEXIVUE MICRO-LENS Inlay

  18. Setting of the laser parameters iFS 150 • Femto parameters: • iPockets software • Depth: 280-300 • Diameter: 4 mm • Bed energy:0.60-0,70 • Spot-Line Sep: 2-2 (or 3-3) • Side cut energy: 1.6-1.7 • Side cut angle: 160 • Deactivate pocket • Suction-applanation FLEXIVUE MICRO-LENS Inlay

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