MMC may help reduce haze associated with Raindrop inlay implantation

The concept of corneal inlays dates back a few decades, and the commercial introduction of the Kamra from AcuFocus and the Raindrop near vision inlay from ReVision Optics has cemented their use in our practices as an additive way of correcting presbyopia without ablating corneal tissue. Inlays are implanted in the stromal tissue and can be removed if needed. All procedures have been shown to improve near function without compromising distance vision because inlays are unilaterally implanted in the nondominant eye. Commercial outcomes have been positive, but there are some drawbacks, namely corneal haze, diminished nutrient supply and pupil size dependency. I have been using the Raindrop near vision inlay since 2013; this particular inlay is 2 mm in diameter and 32 µm thick, or about half the thickness of a human hair. One of its primary advantages over other inlay technologies is that it is composed of transparent hydrogel that has a similar refractive index and water content as the cornea; the positive meniscus shape creates a smooth and continuous power transition. My technique is to implant the device at the center of a light-constricted pupil under a femtosecond laser-created flap. This shape-changing procedure biomechanically alters the corneal shape by raising the anterior stroma. There is virtually no effect past twice the diameter of the inlay, with the greatest effect residing on the center of the inlay.