Near vision can be optimized with scleral micro-inserts

Finding a solution to presbyopia, a condition that affects nearly 90 million Americans and 1.7 billion people worldwide, has long been the holy grail in ophthalmology. Most of our current surgical approaches to presbyopia, including monovision LASIK and multifocal IOLs, provide improved near vision but at the cost of some compromise to distance acuity or quality. I have been involved as an investigator in the clinical trial of the VisAbility micro-insert system (Refocus Group). In this procedure, four tiny PMMA inserts, each about the size of a grain of rice (Figure 1), are implanted in the sclera, outside the visual axis. The micro-inserts are designed to be placed bilaterally. Although the mechanism of action is not entirely clear, it is believed the micro-inserts increase tension on the zonules to partially restore accommodation. As a scleral procedure, the scleral micro-insert procedure is less invasive than an intraocular procedure; it preserves both the cornea and the lens and can be reversed by removing the inserts.