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Kohnen T, Lwowski C, Böhm M, Hemkeppler E, Jandewerth T. Visual Outcomes and Safety of a Refractive Corneal Inlay for Presbyopia: One-Year Results. J Refract Surg 2024; 40:e1-e9. [PMID: 38190559 DOI: 10.3928/1081597x-20231204-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE To determine the visual outcomes and safety 12 months after implantation of the Presbia Flexivue Microlens refractive corneal inlay. METHODS In this prospective, non-randomized trial, 22 patients with a mean age of 52.54 ± 2.86 years were implanted with the Flexivue Microlens refractive corneal inlay in the non-dominant eye at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Corrected near, intermediate, and distance (CNVA, CIVA, and CDVA) visual acuity and uncorrected near, intermediate, and distance (UNVA, UIVA, and UDVA) visual acuity, manifest refraction, subjective quality of vision, endothelial cell count, and contrast sensitivity were measured 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. RESULTS For binocular CDVA, no patient lost two or more lines and 30% lost only one line at the 12-month visit. In the eye that had surgery, 85% of the patients lost two or more lines of UDVA, which was statistically significant. Sixty-five percent of the patients gained one or more lines in binocular UIVA, and 80% achieved 20/40 or better in DCIVA. UNVA showed a statistically significant improvement, with 90% of the patients achieving 20/40 or better 12 months after implantation. A total of 85% gained two or more lines in binocular UNVA. CONCLUSIONS This refractive corneal inlay showed an improvement in binocular UNVA, UIVA, CNVA, and CIVA, whereas binocular CDVA and UDVA were not statistically affected. [J Refract Surg. 2024;40(1):e1-e9.].
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Ma Q, Chen M, Li D, Zhou R, Du Y, Yin S, Chen B, Wang H, Jiang J, Guan Z, Qiu K. Potential productivity loss from uncorrected and under-corrected presbyopia in low- and middle-income countries: A life table modeling study. Front Public Health 2022; 10:983423. [PMID: 36304252 PMCID: PMC9592832 DOI: 10.3389/fpubh.2022.983423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/23/2022] [Indexed: 01/25/2023] Open
Abstract
Objective To estimate the burden of potential productivity losses due to uncorrected and under-corrected presbyopia in LMICs among the working-age population in both the cross-sectional and longitudinal manner. Methods We extracted data for the prevalence of presbyopia from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019. Data for the gross domestic product (GDP) per capita were extracted from the World Bank database and Central Intelligence Agency's World Factbook. We introduced life table models to construct age cohorts (in 5-year age groups) of the working-age population (aged from 40 to 64 years old) in LMICs, with simulated follow-up until 65 years old in people with and without uncorrected presbyopia. The differences in productivity-adjusted life years (PALYs) lived and productivity between these two cohorts were calculated. The potential productivity loss was estimated based on GDP per capita. The WHO standard 3% annual discount rate was applied to all years of life and PALYs lived. Results In 2019, there were 238.40 million (95% confidence interval [CI]: 150.92-346.78 million) uncorrected and under-corrected presbyopia cases in LMICs, resulting in 54.13 billion (current US dollars) (95% confidence interval [CI]: 34.34-79.02 billion) potential productivity losses. With simulated follow-up until retirement, those with uncorrected and under-corrected presbyopia were predicted to experience an additional loss of 155 million PALYs (an average loss of 0.7 PALYs per case), which was equivalent to a total loss of US$ 315 billion (an average loss of US$ 1453.72 per person). Conclusions Our findings highlight the considerable productivity losses due to uncorrected and under-corrected presbyopia in LMICs, especially in a longitudinal manner. There is a great need for the development of enabling eye care policies and programs to create access to eye care services, and more healthcare investment in the correction of presbyopia in the working-age population in LMICs. This study could provide evidences for some potential health-related strategies for socio-economic development.
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Moshirfar M, Henrie MK, Payne CJ, Ply BK, Ronquillo YC, Linn SH, Hoopes PC. Review of Presbyopia Treatment with Corneal Inlays and New Developments. Clin Ophthalmol 2022; 16:2781-2795. [PMID: 36042913 PMCID: PMC9420445 DOI: 10.2147/opth.s375577] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/04/2022] [Indexed: 12/02/2022] Open
Abstract
Presbyopia may represent the largest segment of refractive errors that is without an established and effective refractive surgery treatment. Corneal Inlays are materials (synthetic or allogenic) implanted in the stroma of patients’ corneas to improve presbyopia. These inlays, introduced into the United States in 2015 via the small-aperture corneal inlay (KAMRATM, SightLife Surgical/CorneaGen, Seattle, Washington, United States), were met with an initial wave of enthusiasm. Subsequent models like the shape-changing corneal inlay (RAINDROPTM, Revision Optics, Lake Forest, California, United States) offered excellent results for patients, but longer-term research raised questions about patient safety. At the time of this article, no synthetic corneal inlays are available in the United States for the correction of presbyopia. Other options for presbyopia correction include allograft corneal inlays, trifocal synthetic corneal inlays, pharmacologic therapies, scleral incisions or additive techniques and PresbyLASIK. Presently, allograft inlays consist of corneal lenticules removed from patients undergoing Small Incision Lenticule Extraction (SMILE). We will review corneal inlays and other alternative procedures that may provide effective and predictable treatments for patients with presbyopia.
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Affiliation(s)
- Majid Moshirfar
- HDR Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
- Correspondence: Majid Moshirfar, HDR Research Center, Hoopes Vision, 11820 State St, Draper, UT, USA, Email
| | | | - Carter J Payne
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Briana K Ply
- HDR Research Center, Hoopes Vision, Draper, UT, USA
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Sánchez-González JM, Borroni D, Rachwani-Anil R, Rocha-de-Lossada C. Refractive corneal inlay implantation outcomes: a preliminary systematic review. Int Ophthalmol 2021; 42:713-722. [PMID: 34599717 DOI: 10.1007/s10792-021-02024-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To review all case series of refractive corneal inlay implantation: Flexivue (Presbia, Netherlands), Invue (BioVision, Brügg, Switzerland) and Icolens (Neoptics, Hünenberg, Switzerland) performed in presbyopia patients and to evaluate the reported visual outcomes. In addition, our aim is to provide assessment for complications and to report the satisfaction rates. METHODS PubMed, Web of Science and Scopus databases were consulted using "refractive corneal inlay", "Flexivue Inlay", "Invue Inlay" and "Icolens inlay" as keywords. 147 articles were found, and they were assessed considering the inclusion and exclusion criteria. After filtering, this systemic review included ten articles, published between 2011 and 2020. RESULTS 308 eyes from 308 participants were enrolled in this systematic review. Mean maximum follow-up was 13.9 months. Nine of the ten case series included used femtosecond laser for the corneal pocket creation. Mean pocket depth was 293.75 µm. 77.5% of the eyes reported a postoperative uncorrected near visual acuity of 20/32 or better, and 19.20% of the inlay-implanted eyes achieved an uncorrected distance visual acuity of 20/20 or better. The most prominent complications were halos, pain, photophobia, and poor distance visual acuity. 27 eyes (8.7%) had to be explanted due to complications, such as near-distance spectacle dependence or blurred distance vision. CONCLUSION Refractive corneal inlay outcomes demonstrated high efficacy, safety, and satisfaction rates. Furthermore, it is a reversible technique. However, the findings must be viewed with caution due potential conflict of interest. Further research with higher sample size is needed to validate these findings.
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Affiliation(s)
- José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes St., Seville, Spain.
- Department of Ophthalmology and Optometry, Tecnolaser Clinic Vision, Seville, Spain.
| | - Davide Borroni
- Department of Ophthalmology, Fondazione Banca Degli Occhi Del Veneto Onlus, Zelarino, Venezia, Italy
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Rahul Rachwani-Anil
- Department of Ophthalmology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Hospital Virgen de la Nieves, Granada, Spain
- Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain
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Park WC, Kim CH, Jin SW. Clinical performance of presbyopia correction with a multifocal corneoscleral lens. Int J Ophthalmol 2021; 14:529-535. [PMID: 33875943 DOI: 10.18240/ijo.2021.04.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/24/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To assess the clinical performance of a multifocal corneoscleral lens for the presbyopia correction. METHODS A prospective clinical trial of the Onefit™ A multifocal corneoscleral lens was conducted with 40 participants with presbyopia. At 4wk of continuous wear of the corneoscleral lens, changes in the distance, intermediate, and near visual acuity (VA) were evaluated. The safety of the corneoscleral lens, central corneal thickness (CCT), corneal endothelial cell count, binocular stereopsis, tear film break-up time (BUT), corneal staining, corneal edema, corneal neovascularization (NV), and conjunctival hyperemia were examined. In addition, a subjective questionnaire addressing satisfaction (rated from 1 to 5 points) and discomfort (rated from 1 to 5 points) was administered. RESULTS Forty participants were enrolled in this study. Six participants were excluded because of poor compliance with lens fitting (n=2) and loss to follow-up (n=4). The mean age of the participants was 53.0±4.9y. At 4wk of continuous wear of the corneoscleral lens, the best corrected far, intermediate, and near VA was 0.08±0.11, 0.10±0.12, and 0.10±0.12 logMAR, respectively. These results were significant improvements over the baseline uncorrected VA (far: P=0.004; intermediate: P=0.004; near: P=0.002). CCT, corneal endothelial cell count, binocular stereopsis, BUT, corneal staining, corneal edema, corneal NV, and conjunctival hyperemia were not significantly different between baseline and after corneoscleral lens use. The average satisfaction scores for fit sensation; corrected far, intermediate, and near VA; and ease of handling were 4.1, 3.4, 3.6, 3.5, and 3.4, respectively. The average discomfort scores for dryness, irritation, foreign body sensation, redness, fogging, and halo were 1.7, 1.8, 1.5, 1.7, 1.7, and 1.3, respectively. CONCLUSION Far, intermediate, and near VA are improved in presbyopic patients with the multifocal corneoscleral lens compared to uncorrected baseline VA, without adverse ocular effects. This evidence supports the safety and effectiveness of presbyopia correction with multifocal corneoscleral lenses.
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Affiliation(s)
- Woo Chan Park
- Department of Ophthalmology, Dong-A University College of Medicine, Busan 49201, Republic of Korea
| | - Chae Hoon Kim
- Department of Ophthalmology, Dong-A University College of Medicine, Busan 49201, Republic of Korea
| | - Sang Wook Jin
- Department of Ophthalmology, Dong-A University College of Medicine, Busan 49201, Republic of Korea
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Korenfeld MS, Robertson SM, Stein JM, Evans DG, Rauchman SH, Sall KN, Venkataraman S, Chen BL, Wuttke M, Burns W. Topical lipoic acid choline ester eye drop for improvement of near visual acuity in subjects with presbyopia: a safety and preliminary efficacy trial. Eye (Lond) 2021; 35:3292-3301. [PMID: 33514891 PMCID: PMC8602643 DOI: 10.1038/s41433-020-01391-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/15/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives This study evaluated the safety of topical lipoic acid choline ester (UNR844, 1.5%) ophthalmic solution and its efficacy in improving distance-corrected near visual acuity (DCNVA) in subjects with presbyopia. Subjects and methods This was a prospective, randomized, double-masked, and multicentre clinical trial. Subjects with a diagnosis of presbyopia (n = 75) were randomized 2:1 to UNR844 or placebo. On days 1–7, all subjects were dosed unilaterally (twice a day, b.i.d.) in their non-dominant eye to ensure safety and tolerability prior to days 8–91 when dosing was changed to bilateral (b.i.d.). Clinical assessments, including DCNVA and adverse events (AEs), were recorded at each study visit. Patients who completed the study were recruited into a non-interventional follow-up study that monitored them until 7 months after their final UNR844 exposure. The primary endpoints were safety and the mean change in DCNVA from baseline in the study eye. Results UNR844 administration (n = 50) produced no safety concerns and was well-tolerated, with no clinically-relevant changes in best-corrected distance visual acuity, pupil size, intraocular pressure, or discontinuations due to adverse events. DCNVA improved in the study eye in the UNR844 group compared to placebo during the 91 days of treatment [UNR844 vs. placebo, mean change in LogMAR (SD); −0.159 (0.120) vs. −0.079 (0.116)]. Bilateral DCNVA improved, with 53.1% UNR844 vs. 21.7% placebo subjects gaining ≥10 letters. Improvements in DCNVA were sustained at 5 and 7 months after UNR844 dosing ceased. Conclusions These results support further development of UNR844 ophthalmic solution for the treatment of presbyopia.
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Affiliation(s)
- Michael S Korenfeld
- Comprehensive Eye Care Center Ltd, 901 East Third Street, Washington, MO, 63090, USA.
| | - Stella M Robertson
- Arrochar Consulting, LLC, 7045 Shadow Creek Court, Fort Worth, TX, 76132, USA
| | - Jerry M Stein
- Summer Creek Consulting, LLC, 8101 Rain Dance Trail, Fort Worth, TX, 76123, USA
| | - David G Evans
- Total Eye Care, PA, 6060 Primacy Parkway, Memphis, TN, 38119, USA
| | - Steven H Rauchman
- North Valley Eye Medical Group, 11550 Indian Hills Road, Mission Hill, CA, 91345, USA
| | - Kenneth N Sall
- Sall Research Medical Centre, 11423 87th Street, Artesia, CA, 90701, USA
| | - Subha Venkataraman
- Novartis Pharmaceutical Corporation, 1 Health Plaza, East Hanover, NJ, 07936, USA
| | - Bee-Lian Chen
- Novartis Pharmaceutical Corporation, 1 Health Plaza, East Hanover, NJ, 07936, USA
| | | | - William Burns
- Encore Vision, Inc., 1120 South Freeway, Suite 118, Fort Worth, TX, 76104, USA
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Paley GL, Harocopos GJ. Histopathologic Analysis of Explanted KAMRA Corneal Inlays Demonstrating Adherent Fibroconnective Tissue Scar Formation. Ocul Oncol Pathol 2019; 5:440-444. [PMID: 31768368 DOI: 10.1159/000498944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/11/2019] [Indexed: 12/27/2022] Open
Abstract
Objective To investigate the histologic composition of opaque membranes associated with corneal intrastromal inlays implanted for the surgical treatment of presbyopia. Methods This is an observational case series of KAMRA corneal inlays explanted due to the presence of adherent opaque membranes associated with peri-inlay corneal stromal haze and sent for histopathologic analysis. Routine histology was performed in addition to immunohistochemical staining with myofibroblast and keratocyte markers. Results Eleven explanted inlay specimens were received, of which, after histologic processing, four demonstrated suf-ficient cellular material for histopathologic analysis. The opaque membranes surrounding the explanted inlays were composed of fibroconnective tissue, and myofibroblasts (positive for smooth muscle actin immunostain) were the predominant cell type. Immunostaining for the keratocyte marker CD34 was negative, confirming that the membranes were the result of a reactive scar-tissue formation process and not simply normal corneal stroma adherent to the explant. Conclusions Corneal inlay implantation can lead to the formation of an adherent fibroconnective tissue membrane, suggesting keratocyte-to-myofibroblast transdifferentiation and reactive fibroconnective tissue scar formation that could potentially impact visual potential. Prospective patients should be counseled regarding the risk of this complication, as this may be associated with some risk of incomplete reversibility of the procedure.
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Affiliation(s)
- Grace L Paley
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - George J Harocopos
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Visual Prognosis after Explantation of a Corneal Shape-Changing Hydrogel Inlay in Presbyopic Eyes. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2019; 8:139-144. [PMID: 31598515 PMCID: PMC6778472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The purpose of this case series is to report visual outcomes in patients who underwent explantation of the Raindrop® hydrogel corneal inlay. Retrospective chart review comprising four cases of explantation of the Raindrop® corneal shape-changing hydrogel inlay: pre-implantation, pre-explantation, and post-explantation values for uncorrected distance visual acuity, uncorrected near visual acuity, and corrected distance visual acuity (CDVA) were measured; keratometric and tomographic data were collected using the Pentacam system (Oculus, Inc). Three eyes were explanted for progressive haze after implantation that persisted even after removal; one eye was explanted due to poor visual acuity with no haze formation. All patients experienced decreased unaided and corrected distance visual acuity. Persistent increase in corneal thickness and mean keratometry was noted post-explantation. All four patients regained their original near visual acuities, but one patient had persistent one-line loss in CDVA. There are long lasting tomographic corneal changes following Raindrop inlay explantation. In addition, persistent increased corneal thickness could be related to semi-permanent changes in corneal structure and may account for residual haze experienced by patients. After explantation, patients may not return to baseline CDVA.
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