Having cataracts can be like looking through a frosty or fogged up window, making daily activities difficult. It is the clouding of the eye’s natural lens, a transparent structure in the eye that helps refract light on the back of the retina. The lens are made of protein and water, but when the proteins clump together, a cataract is formed. Most cataracts develop in people over the age of 55.
There are many causes for cataracts, although aging is the most common. According to the National Eye Institute, by the age of 80, more than half of all Americans either have a cataract or have had cataract surgery. Cataracts can also be the results of genetics, environmental issues, medical conditions such as diabetes, or poor nutrition and excessive sun exposure.
After cataract surgery, your vision is restored and you see amazingly well. What can you do to keep your vision from changing again?
That's a question frequently asked after successful eye surgery. Surgeons usually tell you to exercise, eat well, eliminate tobacco, control blood pressure and lipid levels, wear ultraviolet protection and stay healthy. But knowing that your aging eyes will inevitably change, is there a way to slow down that process? What will preserve good vision for the long term?
Small Incision Lenticule Extraction (SMILE) is an exciting, brand-new procedure that has been taking off around the world since its introduction in 2011. The FDA has recently approved it for treatment of nearsightedness in the United States, but patients in Canada have been benefitting from this innovative procedure for a number of years.
Listen to interview with host Eric Michaels & guest Dr. Paul Casey discuss the following:
What is presbyopia?
What is the KAMRA inlay?
Who can the KAMRA inlay help most?
Do all eye surgeons offer this technology?
How can someone get more information on the KAMRA inlay?
To see if you're a candidate for the KAMRA Inlay, visit our website and request a consultation.
Eric (Host): Today we are speaking with Dr. Paul Casey at Nevada Eye Care, an NVISION Company. Dr. Casey is a board-certified ophthalmologist, specializing in corneal and refractive surgery. Dr. Casey, good morning and welcome to eHealth radio.
Dr. Paul Casey: Good morning, and thank you for having me on.
Eric: You’re welcome, so let’s get started with telling us, what is presbyopia?
Dr. Casey: Presbyopia is probably the most common vision problem in the world. It happens to everyone as the eye ages. When we’re younger, we’re able to see far away and then up close, and then far away and up close because we have a lens inside the eye that can change focus, like it does on your camera. You press it halfway down, it makes a noise, and then determines how far away it is from everything. We have that autofocus in our own eye, we don’t realize or hear it when it happens, but it’s going on when you’re younger. As you get older, the lens inside your eye literally gets stiffer and stiffer and stiffer, and our ability to change focus from distance to near gets worse and worse and worse.
Dr. Casey: Presbyopia refers to the condition that happens as we get older and have trouble seeing small type, needing extra light on things, and pushing things further away from us to read until the arms aren’t long enough. It’s incredibly common; people with good vision typically get reading glasses or make whatever adjustments as necessary. People who wear glasses or contact lenses start needing bifocals or reading glasses on top of their contacts. It’s an aging process of the eye that happens and affects everyone as they get older.
Eric: Continuing on, what is the KAMRA inlay, and what would be the history of the KAMRA inlay, and how does it work?
Dr. Casey: The KAMRA inlay is a fascinating new technology that is now FDA approved, available at our practice and others around the country. Of the different types of vision problems that I, and doctors like me, treat, presbyopia has been one of the hardest ones. If you get a stiff lens inside your eye, we can change the focus. We can give a person who has bad distance focus good distance focus usually by doing that with a laser. Similarly, if someone has good near vision, that’s great, but then they can’t see well far away. In conclusion, correcting the eye so that it can see at multiple distances has been very difficult.
Dr. Casey: Historically, there have been procedures that have attempted to try to give people a range of vision. Probably the most known about approach is one called monovision, where we would set one of the two eyes to focus on distance, and the other eye set to focus on near. The patient would then have to adjust their eyes. There is a considerable compromise when you do that; many people can get used to it and have very good success with the monovision set up, either in contacts or in laser vision correction.
Dr. Casey: The KAMRA inlay is a procedure; it’s a device that’s used as part of a procedure that is intended to allow patients to do better than that. The KAMRA inlay doesn’t change the focus from distance to near, as you would in a monovision procedure. It extends the focus so that the eye that’s being treated can see better up close, but continue to see well far away. It’s called the KAMRA because it relies on principles that photographers use when they’re producing photographs and they want the photographs to have a certain type of effect. When you’re taking a photo, you can adjust the size of the aperture. We call that the F-stop in the camera, and if you want to have distance and near both in focus, you would make the F-stop large, which works in reverse. It means that the aperture becomes small and everything is in focus and the depth of focus is great. When you make the pupillary aperture large by opening up the F-stop, you need to be very certain that you focus the camera very carefully. You can focus on something and that will cause the things that are behind it or in front of it to be out of focus, like you would if you were to take a wedding portrait. You would want the background to be fuzzy; it looks nicer in a portrait setting. But if you’re at the Grand Canyon, you’re going to want the person and the Grand Canyon both in focus, so you would want the aperture to be small.
Dr. Casey: The KAMRA works to make your eye work like the latter case that I just explained where both the distance and near targets are in focus. The inlay itself is implanted in the cornea, in the clear window in front of the eye. It only allows certain light rays into your eyes, those that are in focus for both distance and near. It effectively gives you a small pupil in the eye that’s treated. That improves your near vision because the depth of focus is increased but you don’t lose your distance vision. KAMRA inlay is for people who want to have better near vision, but enjoy their good distance vision. It’s really a breakthrough in the treatment of presbyopia, and presbyopia is the most common condition afflicting people on the planet today. It’s pretty important.
Eric: I would say so as well. Now, who can the KAMRA inlay help the most?
Dr. Casey: We typically don’t put a KAMRA inlay in anybody under 45 years of age; they just don’t need it. If you’re still young enough to change focus on your own, you would just use what Mother Nature gave you. Patients over 45 can be helped with a KAMRA inlay. In it’s purest form, you would be talking about a person that already has excellent distance vision but can’t see up close. People using reading glasses would be the mainstream candidates for this procedure. However, we can use the KAMRA inlay in conjunction with other technologies, like LASIK for example, to improve the near and distance vision. We may need to do LASIK to get the good distance vision and use the KAMRA to make that better by improving the near vision as well. It can help a lot of people, whether you have blurry distance and near vision, or blurry near vision only, the KAMRA inlay can work well to provide you that range of vision that people would ideally want.
Dr. Casey: I have never evaluated a patient and said, “Well I can improve your distance vision but you’re going to need reading glasses if you want to do both eyes,” and then hear the patient say, “Well, I just want my distance vision corrected”. It’s natural that if you’re older and you know that you have a problem about distance and near, you’re going to want them both corrected. It really has a very broad applicability because it’s not like LASIK or cataract surgery where you have to have a focus problem, like nearsightedness for LASIK, or astigmatism, or a cataract. This applies to virtually every person as they age.
Eric: Do all eye surgeons offer this technology?
Dr. Casey: The KAMRA inlay has been around for quite awhile around the world where technologies in other countries can get approved faster than they can here in the United States. There is a great deal of experience with this technology and tens of thousands, possibly over 100,000 people are getting surgeries done and have had KAMRAs implanted. However, in the United States, the KAMRA received its FDA approval in 2015, and at this point, it’s not like every doctor is doing it. In our Las Vegas, Nevada market, there’s two surgeons, myself and one other, who are performing KAMRA inlay surgery. In larger markets, there are some times about a half dozen or so. If you go to KAMRA.com, you’ll find your market, you can put your zip code in and find a doctor that offers the technology.
Dr. Casey: It’s not like everybody is doing it, the adoption of this particular technology is fairly intense from the standpoint of a practice or a surgeon. Other technologies are sometimes very easy to adopt them and add them to the list of things that you do. This one requires a lot of training and developing the surgical techniques to place the implant in the cornea. It is best if the surgeon is a specialist and does a lot of corneal surgery to begin with; they sort of understand what’s involved. Potentially, and there was in our practice, a great deal of investment that is required in both diagnostic and therapeutic equipment that enable me to be able to offer the surgery. Those factors have thus far limited the availability of the KAMRA to everybody and to be done everywhere. Over time, more and more surgeons will begin to offer it because the surgery is applicable to such a large segment of people. Half the people that come into my office every day are more potential candidates. Most of those are LASIK surgeons because it is a natural fit. LASIK surgeons or refractive surgeons, who would have previously used a monovision procedure for correcting the distance and near, are now saying that, “I can now do an even better job recovering the distance and near than I used to be able to do so I’m going to make the effort to get this available at my practice too”.
Eric: As far as the KAMRA inlay technology, I’m assuming that people can get more information on the website that you just mentioned?
Dr. Casey: Right. I would probably say if this is going out over the internet and people are going to be all over the place, they are probably going to want to go to www.KAMRA.com and then do a search as I described. Anybody in Las Vegas can call us at Nevada Eye Care and get an appointment with me. I imagine it’s better to have listeners go ahead to the website. They can also learn a lot more about the KAMRA inlay and how it works, and whether they are a candidate. If they want to get a better feel for what is going on or get some literature or read through a few webpages to understand it better, I think that would be the best way to go.