Reading glasses are a factor of life for many adults in their mid-40s, especially as we relay more and more on having to read devices like tablets and smart phones for crucial information throughout the day.

The reason: As you age, the lens in your eyeballs hardens and becomes rigid. This leads to presbyopia, an age-related condition that makes it harder to focus on close objects. According to data, presbyopia affects about 1.8 billion people worldwide.

People with presbyopia often require reading glasses. Fortunately, various modern technologies and treatment options can reduce your dependence on reading glasses by improving your nearsightedness. KAMRA inlay is one example of such options.

Approved in 2015, the procedure produces long-term results with minimal side effects, although surgical data continues to be evaluated.

What Is a KAMRA Inlay?

KAMRA inlay is a relatively new eye treatment that involves implanting a ring in the eye's cornea. The procedure seeks to restore your ability to focus on nearby objects. A KAMRA inlay is smaller, thinner and lighter than a contact lens and helps patients with presbyopia.

The surgery is effective in restoring near vision without compromising long-distance vision. This allows patients to minimize their reliance on eyeglasses.

KAMRA inlays work similarly to a camera. Creating a pinhole effect minimizes and controls the amount of light entering the eye, thereby increasing your perception of nearby objects.

How Does the KAMRA Inlay Work?

KAMRA inlays are only approved in patients who have very good long-distance vision. For patients who don’t, they should get another form of corrective surgery, such as LASIK, before getting a corneal implant. The KAMRA procedure is done by using a layer to make a tiny pocket inside the cornea and then placing the inlay into the new space.

The idea behind KAMRA is similar to that of how a camera works: create a pinhole effect, to minimize the amount of light that enters the eye. This helps the patient focus on objects near them, such as a digital screen, a book, or a newspaper. Like a camera aperture, KAMRA inlays work by increasing the depth of focus. Review of Ophthalmology writes that monovision LASIK surgery cannot offer this benefit.

KAMRA inlay operations can cost anywhere from $7,000 to $8,000. Most clinics will offer financing options, including sliding scales and monthly payments.

Benefits of KAMRA Inlays

Every surgical procedure and treatment carries certain risks and benefits, and KAMRA inlay is no different. Some of the prevalent benefits of this procedure are:

  • The results are long-term
  • The procedure doesn't affect your depth perception
  • It restores near vision without compromising distance vision
  • The procedure is quick
  • In case of a complication, the procedure can be reversed

Risks of KAMRA Inlays

KAMRA inlays are not universally adopted used by ophthalmologists and optometrists. While implanting a KAMRA inlay is a laser-assisted procedure carried out to precision by a computer, surgeons acknowledge known risks with how the eye heals around the inlay.

One Review of Ophthalmology article details how some patient’s bodies treat the inlay as if it were an invasive substance, throwing the body’s protective system “into overdrive.” One doctor said that implanting the inlay into a stromal pocket reduces the chances of this happening with most patients, but it still is a risk.

If a patient elects to have the inlay removed, loss of vision is a danger. There is not a great deal of research on patient satisfaction, so some doctors are reluctant to point patients toward KAMRA inlays.

Downsides associated with the procedure:

  • It's expensive, costing anywhere from $2,000 to $8,000
  • Not everyone qualifies to have the procedure, and the pool of good surgical candidates is small
  • It’s a relatively new surgery, and data is still being collected about long-term results

Limitations of the KAMRA Inlay

The implantation of the KAMRA inlay might still require the patient to use reading glasses. The glasses may not be needed all the time, or they may be of a lower power. Some patients, depending on many factors like age and lifestyle, will have to continue to use their eyeglasses even with the inlay in place.

KAMRA inlays are not meant to be a “magic button” solution for reading vision problems. For this reason, doctors will not recommend the procedure for patients who will have to use their eyes to read text (on page or on screens) for long periods of time or who will need to look at letters and numbers up close. The American Academy of Ophthalmology cautions that patients should realize that even if they get the procedure, “they may still need reading glasses on certain occasions.”

KAMRA inlays are best suited for patients who will read occasionally while still maintaining a normal depth of focus, such as reading a newspaper or text messages.

Furthermore, KAMRA inlays are usually given to older patients, who are already more likely to struggle with dry eyes because of their age. Dry eyes can be made worse by the postoperative healing that a KAMRA inlay implantation requires. Over time, the discomfort will get better, but patients should be made aware of the recuperation time and the inherent discomfort.

This is why doctors are encouraged to give their patients realistic expectations of what KAMRA inlays entail: the benefits, disadvantages, limitations, and possible risks.

Implanting the Inlay

The procedure for implanting the KAMRA inlay might not be an easy one for patients, regardless of their age. The operation could cause temporary blurred vision, difficulty seeing at night, double vision, glare and halos, problems with perceiving colors, and difficulty with contrast sensitivity. There is also a small risk of swelling, infection, thinning, or inflammation of the cornea. All of these issues are temporary. Patients may also feel pain, burning, and dryness in the eye that receives the inlay.

Before a patient thinks about undergoing the KAMRA inlay procedure, they should first have a complete eye examination, and then talk with their doctor and their eye surgeon about alternatives to treatment, such as upgrading to more powerful reading glasses or enacting lifestyle changes. KAMRA has benefits, but it also has risks — some of which cannot be easily or safely reversed. Patients should weigh the pros and cons with their doctor.

Can the KAMRA Inlay Ring Be Removed?

As stated above, your body may reject the inlay ring. In such a situation, the body attacks the ring as it would a foreign substance. If this happens, the ring needs to be removed before causing damage.

Additionally, the surgery may be reversed if you require cataract surgery. Before removing the ring, however, it's essential to discuss the available options with the specialist. There are instances where cataract surgery can be performed without removing the ring.

Ultimately, while KAMRA inlay procedures can help you improve nearsighted vision, you may still require glasses. This procedure, however, does improve your nearsighted vision significantly.

If you're looking to read your newspaper, a book or the screen on your favorite electronic device more efficiently, you should consider getting the procedure done after consulting with your primary healthcare service provider.

Complications & Long-Term Outlook

Notwithstanding the extensive pre-surgery evaluation that every patient should receive, as many as 10 percent of patients will not respond well to the KAMRA inlay. A few patients report that their long-distance vision is blurred, and some struggle discerning objects in the dark.

A doctor speaking with Review of Ophthalmology said that KAMRA inlays remain “complicated,” despite improvements in the technology and operating procedures. The difficulty is that some of the problems mentioned above develop months after the operation, and some of them manifest quite abruptly.

For the most part, anti-inflammatory steroids are prescribed to help the cornea heal around the inlay. If, after three months, the steroids are ineffective, only then should removal of the inlay be considered (with the aforementioned risks).

A number of patients have benefited from the implantation of KAMRA inlays. In 2015, the Clinical Ophthalmology journal published a review of evidence on the use and effectiveness of the procedure, and concluded that KAMRA inlays (and corneal inlays in general) “are favorable options in correcting presbyopia.” They cited their effectiveness in increasing near and medium distance vision, with only a negligible loss in long-distance vision.

This suggests that notwithstanding the well-established concerns of the implantation procedure, it might be a viable option for many people who want an alternative to using reading glasses.

Do You Qualify for KAMRA Inlay Surgery?

While the KAMRA inlay surgical procedure is highly effective, not everyone is a candidate. Before considering the procedure, it's vital to discuss your eligibility with your doctor. There are cases where the procedure fails, and the ring needs to be removed, leading to various complications, like deteriorating vision. To pass the KAMRA inlay legibility criteria, you should:

  • Have above-average farsighted vision
  • Only need reading glasses or distance correction
  • Be between age 40 and age 60
  • Not have a history of extensive dry eye syndrome (although this can be treated before the procedure)
  • Have a maximum pupil size of 6 mm
  • Not need to read small texts a lot or be in a profession that deal with precision
  • Not be using eye medication for other vision disorders
  • Not have cataracts, uncontrolled diabetes, immune system disorders, glaucoma or keratoconus

KAMRA inlays are not designed to help people with cataracts or those who want multifocal intraocular lenses.

The FDA approved the KARMA inlay procedure in 2015. There's still more research needed to understand the long-term effects and eligibility criteria. Before opting for the treatment, make sure you go over your doctor's potential possibilities and outcomes.

References

Corneal Inlays: A Surgical Alternative to Reading Glasses. (May 2019). American Academy of Ophthalmology.

Medical Definition of Presbyopia. (December 2018). MedicineNet.

The Role Of Corneal Stroma: A Potential Nutritional Source For The Cornea. (September 2017). Journal of Nature and Science.

The KAMRA Corneal Inlay in Practice. (October 2016). Review of Ophthalmology.

Risk Management for Corneal Inlays. (July 2017). Review of Ophthalmology.

The KAMRA Corneal Inlay in the Clinic. (November 2015). American Academy of Ophthalmology.

Implantable Inlay Devices For Presbyopia: The Evidence to Date. (2015). Clinical Ophthalmology.

Global Prevalence of Presbyopia and Vision Impairment from Uncorrected Presbyopia: Systematic Review, Meta-analysis, and Modelling. (October 2018.) National Center for Biotechnology Information.

KAMRA Inlay. AcuFocus, Inc.

A Review of Presbyopia Treatment with Corneal Inlays. (June 2017). National Center for Biotechnology Information.

Investigation of the Presbia Flexivue Microlens. (September 2016). U.S. National Library of Medicine.

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