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    Corneal inlays play increasing role in presbyopia

     

    Inlay options

    In 2017, there are three commercially available inlays, each working by a different mechanism. They include the Microlens (Presbia), which is a refractive optic and still pending FDA approval; the Raindrop (ReVision Optics), which acts by reshaping the cornea; and the KAMRA inlay (AcuFocus), a small-aperture device.

    Dr. Crewe-Brown noted that in addition to being removable, the advantages of corneal inlays include preservation of options for future presbyopic correction.

    In addition, they not only provide for good near and intermediate vision, but they also perform better than the alternatives for better preserving distance vision, Dr. Crewe-Brown said.

    “I have implanted thousands of KAMRA inlays and about 350 Microlens inlays, and I have also done thousands of corneal refractive monovision procedures,” he said. “There is  no doubt that my inlay patients have better distance vision.”

    In photopic conditions, patients who have inlays also maintain stereoacuity that is similar to normal binocular vision, and that contributes to good patient satisfaction.

    In addition, inlays can be combined with other refractive surgeries and with cataract procedures.

    “The so-called ‘plano presbyope’ is a very rare breed, and the bulk of my inlay surgeries have been combined with LASIK or PRK,” Dr. Crewe-Brown said.

    The available inlays are not free of limitations. Dr. Crewe-Brown said that the black annulus of the KAMRA has been a rare cosmetic complaint of patients with light colored irides.

    “The ring is hardly noticeable in someone with a dark iris, but in my practice I see a lot of blue-eyed patients in whom it can be visible,” he said.

    As another issue, because they are made of a synthetic material, all corneal inlays carry a risk of biocompatibility issues.

    “We have to acknowledge the critics and skeptics of the inlays who say that the cornea is not a place for a foreign body,” Dr. Crewe-Brown said.

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