A cheer to the new year with presbyopia correction

It is that fun but reflective time of year again when all premium surgeons chanted the famous Scots poem “Auld Lang Syne,” written by Robert Burns in 1778, at the click of midnight on Dec. 31 to head into the 2016 new year. This poem is used traditionally to bid farewell to the old year at the stroke of midnight but by extension has also been used to bid farewell to or end other occasions. The good news is the advancement of presbyopia correction by corneal inlays and more advanced presbyopia-correcting IOLs during this past year will definitely bring cheer this new year to those of us and our patients suffering from the age-related “long-arm syndrome.”The Kamra corneal inlay (AcuFocus) received FDA approval in April 2015, labeled for intrastromal corneal implantation to improve near vision by extending the depth of focus in the nondominant eye of phakic presbyopic patients between the ages of 45 and 60 years old who have cycloplegic refractive spherical equivalent of +0.5 D to –0.75 D with less than or equal to 0.75 D of refractive cylinder and who require near correction of +1 D to +2.5 D of reading add. I have been performing this inlay technology throughout the year and have found it works best in terms of uncorrected near vision gain in those patients who are –0.5 D to –0.75 D sphere preoperatively. The Kamra corneal inlay can be used in post-laser vision correction (LASIK, PRK) patients as an off-label use in my hands, but if patients had prior flap creation with a microkeratome blade, then OCT imaging of the cornea is critical to make sure you create the corneal pocket at least 100 µm below the old LASIK interface and still stay 250 µm from the corneal endothelium. The Kamra works on the pinhole principle, and use of the AcuTarget HD is critical to get proper alignment of the device based on the Purkinje image analysis of the optical and visual axes. Patients with larger angle kappa readings may not be the best candidates for this technology.