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Why presbyopic corneal inlays will change the future

ByJohn A. Hovanesian, MD, FACS

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In the U.S., two different corneal inlays for presbyopia are undergoing FDA clinical trials. The first, PresbyLens (ReVision Optics), is a hydrogel implant placed beneath a LASIK flap or corneal pocket, where it alters the anterior corneal shape. The second, Kamra (AcuFocus), creates a pinhole effect to increase depth of field. Both of these inlays showed very satisfactory results in earlier clinical trials and will hopefully be approved soon. I believe corneal inlays of these types will significantly change the future treatment of presbyopia for the following reasons:

• They provide a better solution than monovision. Most presbyopes are aware of monovision, and many have reservations about it even before trying it. Additionally, monovision limits distance vision significantly in the treated eye. Both the PresbyLens and Kamra increase depth of field, with much less loss of uncorrected distance vision than monovision, according to human studies conducted thus far.
• People trust implants. With a track record of more than 60 years with intraocular implants for aphakia, everyone has heard of lens implants, and psychologically, these corneal inlays fall into the same category of trust. Additionally, unlike laser monovision, these inlays are reversible with fairly straightforward surgery and a complete return to the preoperative refractive state.
• Corneal inlays provide lifetime benefit. Even later in life, when a cataract requires removal, surgery is possible through either of these corneal inlays, and a monofocal lens implant can be placed, allowing the corneal inlay to provide depth of field for uncorrected near acuity. Therefore, a corneal inlay is a lifetime solution for reading vision.

I'm very eager to see how the FDA approval process proceeds for these corneal inlays, as I'm eager to have a better option than monovision to offer my emmetropic presbyope patients.

• Disclosure: Dr. Hovanesian is a scientific advisory board member for ReVision Optics, maker of the PresbyLens inlay.