Small-aperture corneal inlay improves quality of vision

Salzburg, Austria-A corneal inlay (KAMRA, AcuFocus) is proving to be a good treatment option for presbyopia in emmetropic patients.

The eye with the inlay implanted experiences a gain in near and intermediate uncorrected visual acuity with minimal change in distance acuity. While the inlay eye had a slight decrease in contrast sensitivity, the binocular contrast sensitivity was not affected, said Wolfgang Riha, MD, a resident at the University Hospital Salzburg, Department of Ophthalmology, Salzburg, Austria.

Dr. Riha presented results from 24 patients who had the corneal inlay implanted. The patients all had emmetropic presbyopia, a mean age of 52 years, and were followed for 18 months postoperatively. The refractive errors ranged from –0.75 to +0.5 D. The inlay was implanted in a corneal pocket at a depth of 200 μm in the non-dominant eye, he said.

Dr. Riha and his colleagues measured the distance, intermediate, and near visual acuity levels under photopic and mesopic conditions. Patients completed a questionnaire about their satisfaction with the surgical outcomes.

“The patients gained almost six lines in near visual acuity postoperatively compared with preoperatively, with an increase from J7 to J2 in the [eye with the implant] at the 18-month examination,” Dr. Riha said. “There was also a slight gain in the intermediate vision. There was a slight loss of distance vision in the [eye with the implant], but patients maintained 20/20 vision [or better].”

There was also a slight loss in the photopic and mesopic contrast sensitivity in the eye with the implant. However, the contrast sensitivity in that eye remained within normal limits. The binocular contrast sensitivity remained unchanged from preoperatively. This result agrees with other studies of this corneal inlay.

When the patients were questioned about a reduced need for reading glasses, 96% responded yes. The vast majority (92%) could read a newspaper or magazine without glasses, and 88% could work at a computer without using glasses. No patients reported difficulties during nighttime driving.

“After implantation of the . . . inlay, there was some decrease in contrast sensitivity in the [eye with the implant], but no significant loss at the 18-month examination,” Dr. Riha said. “The patients reported no night vision problems but [did have] improved near and intermediate [vision] and less spectacle dependence. There was no significant loss in distance vision. This is an excellent monocular treatment for presbyopic patients.”

Dr. Riha is a consultant for AcuFocus, and the Department of Ophthalmology at University Hospital Salzburg receives clinical research funding.

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