Presbyopia

When we reach our early 40s, we begin to experience the frustrating effects of blurry near vision. We struggle to read the newspaper, see the computer screen, or send a text message – and end up needing reading glasses or contact lenses to see up close. This natural loss of reading vision is called presbyopia, and it eventually affects all of us, even if we never needed vision correction before.

The eye’s natural lens is normally elastic and flexible and works like an autofocus camera lens to automatically adjust and focus our vision. Over time, the lens begins to stiffen and loses its ability to change shape. Your eye stops being able to bring close objects into clear focus.

Presbyopia continues to progress over time. For example, someone who is 45 may only notice it when trying to read tiny print in low light. However, someone who is 52 may need to use reading glasses for almost all near activities.

Presbyopia can, of course, be managed with glasses or contact lenses. However, we can also treat presbyopia with several surgical options. These include:

LASIK or PRK. LASIK or PRK can be used to create monovision, in which one eye is corrected for near vision while the other eye is stronger for distance vision.

Cataract Surgery. If patients are undergoing cataract surgery, there are many different types of intraocular lenses that can be used to correct presbyopia.

Corneal Inlays. Corneal inlays are another way to correct for presbyopia. These are tiny devices that are surgically inserted just under the top layers of the cornea to provide reading vision. Two have received FDA approval in the United States: the KAMRA™ inlay and the Raindrop® Near Vision inlay.

• The KAMRA™ inlay is a mini-ring with an opening, or pinhole, in the center. This pinhole extends the range of focus to provide near vision.
• The Raindrop® inlay is a microscopic lens that typically provides excellent near vision in the treated eye.

From start to finish, the cornea inlay procedure will typically take less than 20 minutes. Numbing drops are used to ensure you are comfortable throughout the procedure, but you may feel slight pressure (for a few seconds) while the doctor uses a laser to create a small opening in the first few layers of your eye, known as the cornea. The inlay is then placed within the opening. Once the numbing drops wear off, your eyes may feel irritated or scratchy, and you may also experience excessive tearing or light sensitivity. This is normal. Your doctor will provide medications to help you manage these symptoms.

Keep in mind that some patients may still require reading glasses for activities such as reading tiny print or reading in low light. In addition, if the inlay is not centered correctly or if the effects are not ideal, your doctor can safely remove the inlay in the office.

Update on Corneal Inlays - May-June 2015
Peer Review. MillennialEYE. This review discusses three corneal inlays commercially available or in development for the treatment of presbyopia.