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BLOG: Corneal inlays could be the answer for emmetropic presbyopes
Now that the AcuFocus Kamra corneal inlay is approved for presbyopia in the U.S., doctors are asking how this technology will fit the 40-plus-year-old patient and fulfill their desire for freedom from reading glasses.
To be sure, inlays are one of the most exciting developments in eye care during our careers because they treat the most challenging patient population, the emmetropic presbyope who has lived more than 4 decades without spectacles. Other options for these patients, such as multifocal lenses and monovision, are often unsatisfactory. This group is just waiting for a better solution.
The first barrier we’ll face in widespread adoption of inlays will be patient perception. Clinicians will need to differentiate this new offering from monovision, against which many younger presbyopes are biased. We can help patients understand the difference by sharing data from FDA trials and clinical studies in other countries, but most convincing are testimonials from friends who’ve had the procedure and media coverage of the success of this technology. This will just take time.
The next barrier to adoption will be the amount of follow-up required after the procedure. According to trial data released by all three companies pursuing inlays in the U.S., all of these implants can create issues of reversible corneal haze or patient intolerability in a small number of patients. Those with dry eye or other comorbidities are most likely to experience these problems. Follow-up for a corneal inlay, unlike LASIK, is more than 1 year, and diligent exams must be scheduled and kept to ensure a safe, desirable outcome. Because this is more labor-intensive than the follow-up with monovision LASIK, it will take clinicians some time to fully be comfortable with adopting inlays as an alternative.
Having participated in clinical trials for the Raindrop inlay from ReVision Optics (not yet FDA approved), I am truly excited about the prospect of using corneal inlays in my patients. The clinical barriers to their safe use require diligence but are not difficult to overcome, and patients are extremely satisfied with their results. I certainly encourage colleagues to learn all you can about these devices so you are ready to offer them to appropriate candidates.
Disclosures: Hovanesian reports he is a consultant to Abbott Medical Optics, Alcon, Bausch + Lomb and ReVision Optics.