Surgical Correction of Presbyopia

Lenticular, Corneal, and Scleral Approaches

Michael Greenwood, MD; Shamik Bafna, MD; Vance Thompson, MD


Int Ophthalmol Clin. 2016;56(3):149-166. 

In This Article

Refractive Optic Inlays

Refractive optic corneal inlays are designed to change the refractive index of the cornea, providing distance vision through a planar central zone that is surrounded by 1 or more rings of varying additional power for near vision. The Flexivue Microlens (Presbia, Los Angeles, CA) is a transparent, 3.0-mm-diameter hydrogel implant containing an ultraviolet blocker. It has a central 0.15 mm opening to facilitate fluid and nutrient flow, surrounded by a planar central zone and a refractive peripheral zone. The peripheral zone has a standard refractive power with an index of refraction higher than that of the cornea with add powers ranging from +1.25 to +3.5 D, in 0.25 D steps. Depending on the additional power, the lens thickness varies between 15 and 20 μm. This inlay is implanted in a corneal pocket at a depth of 280 to 300 μm.

The Flexivue Microlens has received the CE mark in Europe and is in FDA Phase III clinical trials in the United States. In a study of 43 patients with a mean preoperative UDVA of 20/20 and mean uncorrected near visual acuity of 20/50, all patients had an increase in UNVA after 1 week. By 1 year, 93% of patients had a UNVA of J2 or better.[17] In a prospective study of 47 presbyopic emmetropes, UNVA was 20/32 or better for 75% of implanted eyes after 12 months (mean 20/25). Monocular mean UDVA decreased by 3 lines, from 20/20 to 20/50, although binocular UDVA was not statistically significantly affected. Thirty-seven percent of patients lost 1 line of CDVA in the operated eye; however, no patient lost 2 lines. There was a statistically significant decrease in mesopic and photopic contrast sensitivity at a number of spatial frequencies and an increase in higher-order aberrations in the implanted eyes. Overall patient satisfaction and spectacle independence was high, but 12.5% of patients experienced halos and glare 1 year postoperatively.[16] In a previous prospective study in the earlier version of the inlay (InVue lens), 98% of those patients had UNVA of 20/32 or better in the operated eye at 1 year. Uncorrected distance visual acuity was 20/40 or better in 93% of implanted eyes.