Eyeworld

EW FEATURE 78 Intracorneal inlays • March 2016 AT A GLANCE • Corneal inlays offer near vision to presbyopes without as much distance compromise as with monovision. • With inlays, patients tend not to suffer the same quality-of-vision issues as with multifocal intraocular lenses. • Inlays offer the perk of easier removal than IOLs with fewer risks to the eye. by Maxine Lipner EyeWorld Senior Contributing Writer Development of the KAMRA inlay started 13 years ago. "It went through several iterations of design and then started FDA clinical trials 9 years ago, and it has been avail- able internationally since 2011," Dr. Durrie said. This was FDA approved in April 2015. With 2 other inlays, the Raindrop and the Presbia, now in clinical trials in the U.S., interest is mounting. "We're starting to have a lot of interest from ophthalmic surgeons on where this is going to fit within our treatment suggestions for patients with presbyopia," Dr. Durrie said. While all the inlays are geared to change the point of focus of the Presbyopia inlays at the outset: Getting the near view Red reflex of a KAMRA inlay in situ Source: Perry Binder, MD A look back at corneal inlay development and a look ahead to where they may best fit in the realm of presbyopia treatment W ith the ubiquitous problem of presby- opia always looming, approaches to correct this have a ready market. Recently, several corneal in- lays, the KAMRA (AcuFocus, Irvine, Calif.), the Raindrop Near Vision Inlay (ReVision Optics, Lake For- est, Calif.), the Flexivue Microlens (Presbia, Dublin), and the ICOLENS (Neoptics, Hunenberg, Switzerland), have emerged ready to help this ever-growing population. For many years the treatment standard for presbyopia in the U.S. was monovision, whether this was done with corneal laser surgery or implants, according to Daniel Durrie, MD, professor of oph- thalmology, University of Kansas Medical Center, and president, Durrie Vision, Overland Park, Kan. "Monovision works—many surgeons endorse it," Dr. Durrie said. "But when you focus 1 eye up close and the other far away, there is some compromise in stereopsis—some decrease in distance vison in the monovision eye." Also, there is some neuroadaptation that can take months for some patients. While other solutions have been tried, nothing else has caught on. As a re- sult, monovision has been the chief go-to procedure here, he noted. Inlays at the start Corneal inlays have made strides in the presbyopic population. The Flexivue Microlens Source: Gustavo Tamayo, MD near objects, they actually do this in 1 of 3 different ways, said Gustavo Tamayo, MD, director, Bogota Laser Center, Bogota, Colombia. "The KAMRA works with the pinhole effect. The Flexivue Microlens works with a refractive addition to the cor- nea," Dr. Tamayo said, adding that it is akin to a near add in bifocals. As for the Raindrop Near Vision Inlay, it works by increasing the bulk of the cornea, thereby increasing its refractive index. Perry Binder, MD, clinical pro- fessor, Gavin Herbert Eye Institute, University of California, Irvine, Calif., pointed out that of these inlay approaches, only the one that increases the depth of focus, the KAMRA inlay, is age-insensitive. The others, the Raindrop, the Flexivue, and the ICOLENS, work primarily by correcting a fixed focal length, he noted. "To get a change in correc- tion with these inlays as patients get older, you've got to change the inlay or go to spectacles, contact lenses, or PRK," Dr. Binder said. "Depth of focus stays forever—that does not change irrespective of age." "I think current inlay models are all viable, and they probably will be used for different patients," Dr. Durrie said. "The KAMRA inlay has been the most flexible because of the depth-of-focus principle and

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