The Kamra corneal inlay (AcuFocus) is currently our most popular presbyopic solution, even ahead of presbyopia-correcting IOLs. Having now amassed a great deal of experience with the inlay, we are extremely confident in its ability to deliver safe and predictable postoperative results and in its capacity to extend our patients’ range of vision.
For this reason, we continue to use the Kamra inlay more frequently and are excited to recommend it to our patients. The Kamra inlay compliments our other offerings and, generally speaking, has helped to raise the awareness of refractive surgery. It has also given us the ability to treat a wider range of patients and has increased our referral base, mainly because we have more happy patients referring family and friends who are interested in refractive surgery back to our practice.
In order to appreciate the successes we’ve had with the Kamra inlay, we have to (1) respect the evolution of the procedure and (2) understand the nuances of the procedure.
A BRIEF HISTORY
When the Kamra inlay was first introduced in Europe, in 2009, the inlay was placed underneath a shallow LASIK flap. Very quickly surgeons noticed that this surgical strategy was not optimal, as the patient was at an increased risk for inflammation, delayed healing, and dry eye postoperatively.
What happened over the years is that the surgical technique evolved, allowing us to maximize postoperative results as well as the patient experience.
One step in this journey was determining the best method of insertion. Rather than implanting the inlay underneath a LASIK flap, it was implanted within a corneal pocket, deeper in the cornea. Another step in the procedure’s success was understanding that it works best when the patient is slightly myopic preoperatively. Lastly, recognizing that a pristine ocular surface creates a pristine surgical environment has heightened the success we have had with the Kamra inlay. With the ocular surface cared for, the patient’s healing process is faster, facilitating many visual benefits.
A quick and easy way to remember the nuances of the Kamra inlay procedure is to think of the acronym MOD, where M stands for myopia, O for ocular surface, and D for deep.
Myopia. The most important thing that lends to success with the Kamra inlay is that there is an ideal preoperative refractive target. The inlay performs its best when implanted in a slightly myopic (at least -0.75 D) eye. Most patients are not walking into the office with that type of prescription, so in many instances, it is up to us to get the patient to that ideal refractive target prior to implanting the inlay. When this is achieved, we can maximize the function of the Kamra inlay and get the patient in that perfect range for visual success.
Ocular surface. Just like with any premium presbyopic solution—multifocal IOLs, PRK, LASIK, and even refractive cataract surgery—it is important to first manage the ocular surface prior to implanting the Kamra inlay. Any high-performance optic is more sensitive to dry eye, and so addressing that and controlling that prior to surgery is crucial.
Deep. Placing the inlay deeper within the cornea, at 40% of the total corneal thickness or deeper (at least 250 µm), allows the inlay to be placed in a less reactive space in the cornea. Implantation into a corneal pocket has helped facilitate deep implantation, which, in my experience, has virtually eliminated the risk of haze and has decreased the concern of dry eye because we are no longer severing as many corneal nerves. These two things have helped with predictability and, in return, patient tolerance.
A TREASURE TROVE
In the following pages, seven surgeons and optometrists will explore these MOD success factors in detail. They are true experts in the field of corneal inlays, and they represent a combined total of more than 1,000 Kamra inlay procedures and patients. Additionally, some even have the Kamra inlay implanted in their own eyes and are extremely happy with the outcomes.