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    Minimally invasive surgical solutions for presbyopia

    Corneal and scleral implants offer options beyond spectacles or contact lenses

    Presbyopia, an age-related loss of accommodative amplitude of the eye resulting in near and intermediate vision deficits, begins to affect most people once they reach their early 40s. Although easily managed with corrective glasses, some natural emmetropes—particularly individuals who became emmetropic after undergoing laser vision correction—prefer to remain spectacle-free.

    Contact lens monovision that targets the non-dominant eye for near vision is a longstanding and widely used approach for treating emmetropic presbyopia.

    Related: Managing presbyopia with surgery

    However, this option is not ideal for everyone. Not all individuals adapt to contact lens monovision. Some patients do not consider contact lens wear an acceptable alternative to spectacles. Even individuals who are successful with contact lens monovision must accept compromises that include decreased distance vision in the non-dominant eye and reduced stereopsis.

    The search for surgical solutions for presbyopia has led to the development of pseudophakic intraocular lenses (IOLs) that use various optic designs to provide an extended range of uncorrected functional vision. Most individuals ages 40 to 60 years old, however, have a clear crystalline lens and do not need cataract surgery.

    For these patients, corneal inlays offer a minimally invasive surgical approach for treating presbyopia.

    Presbyopia-correcting inlays

    Treatment of presbyopia with a corneal inlay is a monocular procedure that involves placement of the device into the non-dominant eye.

    Two devices, Kamra inlay (AcuFocus) and Raindrop Near Vision Inlay (ReVision Optics), are approved by the U.S. Food and Drug Administration (FDA) with indications for use in phakic presbyopes who have minimal spherical refractive error and do not require glasses or contact lenses for clear distance vision (see Table 1).

    Related: New correction option for presbyopes

    Jeffrey Whitman, MD
    Jeffrey Whitman, MD, is president and chief surgeon of the Key-Whitman Eye Center in Dallas.

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