Luke Rebenitsch, MD

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Dr. RebenitschFor more than two decades, ClearSight Center has been a vision correction practice. It began in the radial keratotomy (RK) days and quickly switched to LASIK and PRK when they became available.

	With the FDA approval of a corneal inlay (Kamra, AcuFocus) and now the Raindrop inlay (ReVision Optics), the entire presbyopia market has just begun to open up. We have recognized this opportunity and are now including the inlay and refractive lens exchange as surgical options for presbyopia, and the practice has benefitted with tremendous growth.

New corneal inlay offers choice for presbyopia improvement

	Presbyopia currently affects about 1.7 billion people worldwide, a number that is expected to grow to 2.1 billion by the year 2020.

	Until now, this has been a vastly underdeveloped market as there was a scarcity of treatment options. While the presbyopia market is growing, it is not nearly as robust as the LASIK market. This is due in large part to the fact that while most people have heard of LASIK or PRK and understand the concept of utilizing lasers for vision correction, very few know about presbyopia and the use of inlays. In fact, about 75% of the patients who present in the office need to be educated on presbyopia and the options for treatment.

Understanding pros, cons of the latest corneal refractive procedure

	Since we started offering the inlay, I make sure that 100% of patients that come to our office are educated in presbyopia and treatment options available-both for their own betterment and so they can pass along the knowledge to others.

	Having an educated staff plays a significant role in the ability to educate patients. Staff should be fully versed in the anatomical changes behind presbyopia, how the pinhole effect works, and how monovision differs from inlays. This is especially important for those who are not yet presbyopic or who may never have heard of presbyopia.

Toric trifocal IOL brings expanded range of functional vision to larger patient population

	A commitment to educating patients about presbyopia and providing premier treatment options for it is fully ingrained in our staff. It is just as important as LASIK, refractive lens exchange, or any other refractive procedure. By the time I see a presbyopia-aged patient, I now expect to have had at least two or three people have the conversation with that patient about the KAMRA inlay and other presbyopia-correcting surgical options. Keeping privacy in mind, previous successes are often passed on as well. This internal marketing has been of the utmost importance.

	Most patients with presbyopia will not present to a traditional ophthalmic or cataract practice. They will walk into either their long time eye care provider looking for advice or will perhaps present to a refractive surgery practice. These are people who want to feel younger and be free of the need for spectacles, but are initially generally unaware of presbyopia and the options for treatment.

Why single-instrument screening for keratoconus remains a dream

	We educate everyone who comes into the office, but we also strive to educate the general public about presbyopia and its treatment options through marketing. This is to create awareness that there are other options beyond LASIK and reading glasses.

	In our practice, with regards to external marketing, the same platforms useful for marketing to LASIK patients has worked well for the presbyopic demographic. The four platforms we focus on are: radio, social media (especially Facebook), a booth at our State Fair, and email updates to our existing patients. Our strategy is mainly to educate the public that there are technologies available for presbyopia that include the KAMRA inlay, refractive lens exchanges, and LASIK.

	Our most effective campaign in our metro area has been radio. We do not necessarily market the inlay specifically, but we market that there exist new treatments that will eliminate the need for reading glasses and bifocals. We explain that there have never been mechanisms to treat presbyopia available before as there are now. The response to this type advertisement of has been remarkable.

	We were the first in our community to offer this technology and our first 20 patients were extraordinarily easy to obtain. Since then, the clinic has been full of those wishing to be rid of readers and bifocals. There are many weeks we do not have the time to schedule all those who would like consultations. The patients are there-they just need to be made aware of the options that are available.

	The ideal corneal inlay patient is between the ages of 45 to 60 years-in essence, an older LASIK patient who would have required monovision or readers. The guidelines dictate that they should have a cycloplegic refraction between +0.50 D and -0.75 D and less than or equal to 0.75 D of refractive cylinder. We have found that most patients would benefit from LASIK, and we have created a package to allow them the best vision possible. In our practice, we use concurrent or staged LASIK to target -0.75 D for the inlay eye (non-dominant) and the dominant eye should reach plano. This typically results in most patients not requiring correction for the vast majority of their activities. Of course, any underlying allergic or dry eye issues should also be addressed prior to inlay implantation.

What a novel scleral implant may mean for presbyopia

	Our patients generally do very well after surgery and the recovery time has been surprisingly quick when targeted with excimer laser appropriately. Prior to surgery, we provide significant education about the postoperative healing process so patients understand the importance of the postoperative medications as well as what can be a slower healing process. Most patients can see the benefits after just a day, but there are others that take longer. With proper education, nearly all patients are happy early on as they can still see things they have not been able to for years.

Technique targets source of rainbow glare symptoms

	Adding the corneal inlay into a general or refractive surgery practice can be a great benefit to patients and the practice when done correctly. Communities simply need to be educated about presbyopia and the new technologies available. Within the first 2 months of offering the inlay, volume increased 20% to 30%. In 1 year, our return has far exceeded our investment. It has also increased other presbyopia procedural volume well beyond what we thought possible in a short time. As many can attest who are there, there is a great frustration with reading glasses and bifocals. Any practice that provides great outcomes and educates appropriately should not have a problem finding patients.

The 5 greatest ophthalmic innovations of the 21st century

Market Scope, Global Presbyopia-Correcting Surgery Market Report, April 2012.

	2. Lindstrom RL, Macrae SM, Pepose JS, Hoopes PC. Corneal inlays for presbyopia correction. 

	Dr. Rebenitsch is a board-certified refractive surgeon at ClearSight LASIK in Oklahoma City, OK. He did not indicate any proprietary interest in the subject matter.

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Adding the corneal inlay into a general or refractive surgery practice can be a great benefit to patients and the practice when done correctly.

Luke Rebenitsch, MD

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