A KAMRA inlay is a tiny lens that is surgically placed into the cornea. It is usually given to elderly patients who are losing their vision. It can reduce the need to wear glasses for light reading and everyday activities. (Learn More)

Not everyone is a candidate for receiving KAMRA inlays. It depends on the current health of their eyes. Some people’s bodies reject the implantation of the KAMRA inlays, and for others, the healing process can be extensive. (Learn More)

If necessary, the implants can be removed. While most patients’ vision will return to preoperative levels, others might have vision problems with the affected eye. (Learn More)

What Is a KAMRA Inlay?

A KAMRA inlay is a type of corneal inlay, which is a tiny lens or another kind of optical device that is surgically inserted into the cornea to boost reading vision. The American Academy of Ophthalmology calls corneal inlays “a surgical alternative to reading glasses.”

The main purpose of KAMRA inlays is to improve close-up vision and to help older adults who have presbyopia (literally, “old eye,” the slow age-related loss of the eyes’ ability to focus on nearby objects). They will then not have to rely on their reading glasses as much.

As people age, the lens in their eyeballs harden, becoming less flexible with the passage of time. With the loss of this elasticity, the eye will struggle to focus on close objects, like words on a page or screen.

Presbyopia is a natural occurrence, affecting almost 1.7 billion people around the world.

The KAMRA Inlay, created by AcuFocus, was approved for use in the European Union in 2010 and in the United States in June 2014. The inlay rests in the stromal bed, one of the layers within the cornea.

The inlay is smaller, lighter, and thinner than a contact lens, resembling a small ring with an opening in the middle. This opening allows only focused light to reach the eye. The non-KAMRA eye is not affected or touched by any of this.

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.

Risks of KAMRA Inlays

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

Another Review of Ophthalmology article explains that some patient’s bodies treat the inlay like an invasive substance, which it is to a degree, and the body’s protective system “goes 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.

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

Additionally, KAMRA inlays are not designed to help patients who are suffering from cataracts or patients who want multifocal intraocular lenses. This means that the number of people who can receive KAMRA inlays is very small, and they would likely need further vision correction should they develop cataracts after the implantation of the inlay.

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 & Removing 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.

As mentioned earlier, the KAMRA inlay can be removed, and in most cases, vision returns to the level the patient had before the procedure. However, there is no guarantee that the patient will receive their pre-surgery vision levels, or that there will not be any long-term changes to vision in that eye.

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.

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.

 

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.

Weighing the Pros and Cons of Inlays. (March 2017). EyeWorld.

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