A recently approved eye treatment offers a safe, long-term solution for that very annoying problem of aging: the inability to read close-up.
The condition, called presbyopia (which literally means “old eye” in Greek) happens to nearly everyone and usually hits sometime after age 40. You’ll find yourself squinting to read menus or whipping out glasses to check your iPhone.
Approved last June by the FDA, the Raindrop Near Vision Inlay is a permanent, implantable device that restores close-up vision.
“It allows you to turn back the clock,” said Dr. Steven Stetson, the medical director of Diamond Vision, who became certified to implant the inlay last fall.
He said the treatment is allowing people in their 40s, 50s, and sometimes even 60s to read without glasses.
The Raindrop inlay is only the second permanent, implantable lens approved in the United States. Dr. Stetson, who is also certified to implant the other FDA-approved inlay, called the KAMRA, said that it depends on each individual which inlay treatment works best.
For some, the Raindrop may perform better in dimmer light conditions, since it does not block any light to function, said Dr. Stetson. However, since the KAMRA inlay is placed in a small pocket instead of under a larger flap, patients may not need to take eye drops for as long afterward as with the Raindrop. Each patient is different and may heal at different rates, he added.
For both types, only one inlay, implanted in the non-dominant eye, is enough to correct vision.
Dr. Stetson said data from Europe, where these inlays have been in use for more than five years, indicate that vision improvement after the treatment is long-term.
How Inlays Work
The Raindrop corrects vision by changing the slope of the eye.
“It makes the central cornea steeper—profocal, kind of like a hawk eye or like eagle eye,” Dr. Stetson said.
The Raindrop looks like a small, clear contact lens and is made of a similar hydrogel material, he said.
It is implanted about a third of the way into the cornea, directly over the pupil. The inlay is a relatively thick compared to the thickness of the cornea, so when it is implanted it changes the curvature of the middle of the cornea, Dr. Stetson said.
The steeper slope allows people to focus more easily on nearby objects but because the inlay is small, the periphery of the cornea is unchanged and can still focus at a distance.
The other inlay, the KAMRA, corrects vision with a very different principle. The much thinner device (only 6 microns thick) is a dark brown color with a pinhole in the center. Light passing through the pinhole is focused when it hits the retina. This focus is necessary to see objects close up.
Young eyes have soft, flexible lenses, but with presbyopia, the lens becomes stiff and less able to focus on close images. The KAMRA inlay eliminates the need for the lens to focus because light passing through the pinhole is already focused.
Who’s a Candidate?
Dr. Stetson said a big part of the reason these inlays are so successful is because doctors offer them to the right patients. He won’t put the inlay in a person he does not think is a good candidate.
An employee in his Georgia office once flew to Manhattan with her husband so they could both get an inlay. But it turned out only her husband was a suitable candidate.
“She was very heartbroken about that, but I think she’s forgiven me,” Dr. Stetson said.
The Raindrop is licensed for people 41 to 65 years old who have not undergone cataract surgery or a PRK (photorefractive keratectomy). This is because with PRK the layer just beneath the surface is disrupted and can change how the surface cells remodel, reducing the effect of the Raindrop, Dr. Stetson explained.
The KAMRA, approved for 45- to 60-year-olds, is more versatile because its smaller size does not change the shape of the cornea, and it is placed deeper in the cornea.
Pre- and Post-Op Care Is Key
For both inlays, the procedure to implant them is “very simple and very easy for the patient,” Dr. Stetson said.
The surgeon uses a laser to cut a very precise flap in the cornea then slips the device into place. The operation takes only 10 to 15 minutes.
Side effects are minimal, but proper pre- and post-op care is essential. Patients with a history of dry eyes should seek treatment for the condition beforehand.
Diamond Vision clinics have an array of laser, LASIK, and dry eye treatments that will prepare eyes for an inlay. Afterward, patients generally need to use anti-inflammatory eye drops for two to three months.
And while it may take up to three weeks to regain distance vision in the operated eye, many patients can read again shortly after surgery.
“Near vision usually comes back quickly. In many patients, it’s within a few days,” Dr. Stetson said.
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