Corneal inlays

The Raindrop Near Vision Inlay (ReVision Optics) appears to fulfil all the requirements of an ideal corneal implant for the correction of presbyopia, said Patrick Versace MD, who is in private practice in Sydney, Australia.

“The Raindrop inlay is now our preferred treatment for the emmetropic presbyope. It has minimal impact on uncorrected distance visual acuity and provides excellent spectacle independence,” Dr Versace told the XXXIII Congress of the ESCRS in Barcelona, Spain.

He noted that their preference is based on their experience with 60 consecutive presbyopic patients who underwent implantation of one of three different types of corneal inlays in their non-dominant eye at their centre over a period of six years.

The first inlay they used was the KAMRA inlay (AcuFocus), which they implanted in 47 patients as part of an FDA trial. The 3.8mm diameter implant is opaque except for a 1.6mm aperture which increases the depth-of-focus through the pinhole effect.

Dr Versace and his associates found that, in general, patients achieved good gains in near visual acuity without any significant loss of distance visual acuity. However, 30 per cent of eyes had a hyperopic shift greater than one dioptre over the first postoperative year and 10 (21 per cent) of the inlays were removed as a result.

NEAR FOCUS

Dr Versace and his associates also implanted a small series of the Presbia Flexivue Microlens™ (Presbia). The corneal inlay is 3.2mm in diameter and has a central 0.51mm hole within 1.6mm nonrefractive zone. Surrounding that is a refractive annulus designed to provide a gradation of near focus from +1.5D to +3.5D.

In the eight patients who underwent implantation of the Flexivue inlay, functional near vision was good. However, several patients lost lines of corrected distance visual acuity in the operated eye and three implants were explanted as a result.

The next inlay Dr Versace and his associates tried – and the one they have settled on for the time being – was the Raindrop Near Vision Inlay (ReVision Optics). The clear hydrophilic hydrogel inlay is designed to provide a broad depth-of-focus by reshaping the anterior corneal shape while also inducing a small myopic shift. The implant is best suited for emmetropes and those with a small amount of hyperopia.

Among the five patients implanted with the inlays at his centre, all achieved an uncorrected binocular visual acuity of 6/6 or better for distance and a monocular near visual acuity of N5 or better in their treated eye at one month. “At present, the Raindrop ticks the boxes for me. It has good functional near vision, you preserve binocular function and distance vision is minimally affected. There are also very few photopic symptoms and the cornea seems to tolerate it well,” said Dr Versace.

Patrick Versace:
patrick.versace@bigpond.com