Eye drop may provide a pharmacological treatment for presbyopia

Ophthalmologists are currently well-equipped to address a variety of refractive errors with surgical remedies. Laser vision correction for myopia, astigmatism and hyperopia has arguably reached a relative plateau of high-quality visual correction. Incremental improvements will inevitably occur, but the latest generation of lasers is producing extraordinary results. Additional technologies such as phakic IOLs, corneal intrastromal lenticule extraction and refractive lens exchange are carving out their place as well. Presbyopia correction remains an area of relative weakness in our armamentarium. While corneal inlays and multifocal excimer laser ablations are used internationally to correct presbyopia, these treatments are not available in the United States. In the U.S., the only currently available treatment for presbyopia involves the use of accommodating or multifocal IOLs. A reliable, high-quality treatment for presbyopia would be a true game-changing event.All efforts to surgically correct presbyopia require some form of optical compromise. In the case of corneal inlays, the goal of treatment is either a multifocal cornea or the creation of a pinhole within the cornea. Either situation inevitably reduces contrast sensitivity. Corneal inlays have achieved a decent level of penetration internationally, and several ophthalmologists have received these inlays in their own eyes. Implantation in the nondominant eye is the typical application of these devices, owing to their small but real effect on visual quality. The Kamra inlay (AcuFocus) utilizes a central 1.6-mm aperture to achieve its expanded depth of focus. The selection of 1.6 mm was not arbitrary. With too small or too large of an aperture, vision degrades significantly.