Corneal Inlays for Presbyopia Correction

Richard L. Lindstrom; Scott M. MacRae; Jay S. Pepose; Phillip C. Hoopes Sr

Disclosures

Curr Opin Ophthalmol. 2013;24(4):281-287. 

In This Article

Abstract and Introduction

Abstract

Purpose of review This study provides an overview of the three types of corneal inlays now in use for the correction of presbyopia and reviews recently published evidence of the inlays' safety and efficacy.

Recent findings Results for corneal reshaping and refractive inlays are promising, but very limited. Small-aperture inlays are already in widespread use and have been shown to improve uncorrected near and intermediate vision without a significant loss in distance acuity or an unacceptable increase in visual symptoms. Complications have been minimal, but the inlays may be removed if necessary. They do not prevent visualization or imaging of the retina and may be retained during subsequent cataract surgery.

Summary The presbyopic demographic is large and growing, with a high level of interest in spectacle independence. There is currently no other effective solutions for presbyopes who desire good uncorrected vision at all distances without the risks of intraocular surgery or the visual compromises of monovision. Additional research is needed, but the future for corneal inlay technology is bright.

Introduction

Currently there are more than 140 million people over the age of 40 years in the USA alone[1] and it is expected that, by 2020, there will be 2.1 billion presbyopes worldwide. With these demographic trends comes a continuing interest in the development of refractive surgical procedures to improve near vision for presbyopic patients.

Current surgical interventions for presbyopia include corneal refractive surgery with a monovision or blended vision target; a number of surgeons have also investigated multifocal ablations. These options, like their contact lens counterparts, may reduce distance acuity, stereopsis, contrast sensitivity, or quality of vision. With refractive lens exchange, the patient may have monovision, accommodating or multifocal intraocular lenses (IOLs) implanted prior to the development of clinically significant cataract. However, many consider clear lens surgery too invasive, particularly in the early stages of presbyopia. For all these reasons, there is significant interest in corneal inlays to correct presbyopia.

The advantages of corneal inlays include the fact that they are additive and do not remove tissue, they preserve future options for presbyopic correction, some of them may be used in the setting of pseudophakia and/or combined with laser refractive surgery, and they are all removable.

At present, there are three types of corneal inlays in various stages of development and commercial release. These include refractive inlays that alter the index of refraction with a bifocal optic, one that changes the corneal curvature, and one that relies on small-aperture optics to increase the depth of focus. Over the past 18 months, the number of peer-reviewed publications about these devices has grown tremendously ( Table 1 ).[2–9]

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