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The Kamra Inlay How This Premium Presbyopia Solution Can Improve Your Practice

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The Kamra Inlay How This Premium Presbyopia Solution Can Improve Your Practice Supplement to January 2018 Sponsored by AcuFocus GOING MOD Simple Rules for Inlay Success GOING MOD The Kamra Inlay How this premium presbyopia solution can improve your practice. BY WILLIAM F. WILEY, MD he Kamra corneal inlay (AcuFocus) is currently our most pop- inlay performs its best when implanted in a slightly myopic (at least ular presbyopic solution, even ahead of presbyopia-correcting -0.75 D) eye. Most patients are not walking into the office with that TIOLs. Having now amassed a great deal of experience with the type of prescription, so in many instances, it is up to us to get the inlay, we are extremely confident in its ability to deliver safe and patient to that ideal refractive target prior to implanting the inlay. predictable postoperative results and in its capacity to extend our When this is achieved, we can maximize the function of the Kamra patients’ range of vision. inlay and get the patient in that perfect range for visual success. For this reason, we continue to use the Kamra inlay more fre- Ocular surface. Just like with any premium presbyopic quently and are excited to recommend it to our patients. The solution—multifocal IOLs, PRK, LASIK, and even refractive Kamra inlay compliments our other offerings and, generally speak- cataract surgery—it is important to first manage the ocu- ing, has helped to raise the awareness of refractive surgery. It has lar surface prior to implanting the Kamra inlay. Any high- also given us the ability to treat a wider range of patients and has performance optic is more sensitive to dry eye, and so address- increased our referral base, mainly because we have more happy ing that and controlling that prior to surgery is crucial. patients referring family and friends who are interested in refrac- Deep. Placing the inlay deeper within the cornea, at 40% of tive surgery back to our practice. the total corneal thickness or deeper (at least 250 µm), allows In order to appreciate the successes we’ve had with the Kamra the inlay to be placed in a less reactive space in the cornea. inlay, we have to (1) respect the evolution of the procedure and Implantation into a corneal pocket has helped facilitate deep (2) understand the nuances of the procedure. implantation, which, in my experience, has virtually eliminated the risk of haze and has decreased the concern of dry eye because we A BRIEF HISTORY are no longer severing as many corneal nerves. These two things When the Kamra inlay was first introduced in Europe, in 2009, have helped with predictability and, in return, patient tolerance. the inlay was placed underneath a shallow LASIK flap. Very quick- ly surgeons noticed that this surgical strategy was not optimal, A TREASURE TROVE as the patient was at an increased risk for inflammation, delayed In the following pages, seven surgeons and optometrists will healing, and dry eye postoperatively. explore these MOD success factors in detail. They are true experts What happened over the years is that the surgical technique in the field of corneal inlays, and they represent a combined evolved, allowing us to maximize postoperative results as well as total of more than 1,000 Kamra inlay procedures and patients. the patient experience. Additionally, some even have the Kamra inlay implanted in their One step in this journey was determining the best method of own eyes and are extremely happy with the outcomes. n insertion. Rather than implanting the inlay underneath a LASIK flap, it was implanted within a corneal pocket, deeper in the cor- nea. Another step in the procedure’s success was understanding that it works best when the patient is slightly myopic preopera- WILLIAM F. WILEY, MD tively. Lastly, recognizing that a pristine ocular surface creates a pristine surgical environment has heightened the success we have n [email protected] n Financial disclosure: Medical advisory board (AcuFocus) had with the Kamra inlay. With the ocular surface cared for, the patient’s healing process is faster, facilitating many visual benefits. Q: How many Kamra inlays have you implanted? A: In our practice, we've done about 250 inlays over the past 18 months. PROCEDURAL NUANCES Q: What are you able to achieve on average for near and far acuity? A quick and easy way to remember the nuances of the Kamra A: In the inlay eye, 20/25 would be a reasonable goal for distance and J1 for near. inlay procedure is to think of the acronym MOD, where M stands Patients will realize that the inlay eye is giving better function than the non-inlay eye, for myopia, O for ocular surface, and D for deep. and they can appreciate that, particularly if they've undergone LASIK with both eyes. Myopia. The most important thing that lends to success with the Kamra inlay is that there is an ideal preoperative refractive target. The M MYOPIA O OCULAR SURFACE D DEEP Simple Rules for Inlay Success Myopia: Why Refraction Matters The ideal preoperative refraction with the Kamra inlay is -0.75 D, and here’s why. BY MICHAEL B. WILCOX, MD; AND R. LUKE REBENITSCH, MD e have both been offering the Kamra corneal inlay (AcuFocus) at our prac- Wtices now for about 2 years. Over the course of this time, we’ve homed in on the ideal preoperative refraction that allows the inlay to perform its best within the eye. That refraction is -0.75 D. HOW IT WORKS The Kamra inlay is a laser-etched micro- disc with a hole in its center. The overall size is 3.8 mm in diameter, and the central opening is 1.6 mm. The design of the Kamra inlay works much like a camera lens. The f-stop of a camera correlates to the size of the aperture, or the opening that controls the amount of light that penetrates the lens; the larger the f-stop, the smaller the aper- ture and, therefore, the more depth of focus it creates. Figure 1. The small aperture flattens the existing defocus curve around the patient’s pre-existing MRSE, resulting in gains When a photographer takes a picture at near and far. When that MRSE is plano, the far vision benefit is not appreciated as it is added onto infinity. Near vision of objects at different depths, he or she improves, but not necessarily to the degree desired by the patient. would choose a high f-stop to increase the depth of focus and ensure that the objects in the front and those in the back all are in focus. The Kamra inlay works the same way, in that it incorporates a small aperture to increase depth of focus. Essentially that aperture eliminates blur by blocking peripheral defocused light, allowing more parallel rays of light to enter the eye. This system is ideal for enhancing near vision without sacrificing distance vision, which is exactly what our presbyopic patients are searching for. WHY -0.75 D? What has been found through studies and clinical investigations is that people who are -0.75 D preoperatively are the happiest Kamra inlay patients. The reason for that is because the inlay extends the patient’s natural focus in both near and far directions Figure 2. When the inlay eye has an MRSE of -0.75 D prior to implantation, more of the extended depth of focus provided by (Figure 1). the small aperture is appreciated by the patient. Both far and near vision are improved. JANUARY 2018 | SUPPLEMENT TO CATARACT & REFRACTIVE SURGERY TODAY 3 GOING MOD In simpler terms, the Kamra inlay pro- motes extended depth of focus and helps produce a visual acuity of about 20/25 at distance and J2 at near in the inlay eye. Having the Kamra inlay extends patients’ focus back out on either side of their natural focus points and brings them in up close to boost near vision. In plano patients, near vision will not be as strong as it is in -0.75 D patients (Figure 2). Likewise, in patients who are -0.50 D preoperatively, they will not fare as well as the -0.75 D patient, and they are more likely to be disappointed with their results. Furthermore, over time, the -0.50 D patient would start to lose some of his or her near vision. Therefore, when- Figure 3. Patients maintain excellent distance vision over time after Kamra inlay implantation. ever possible, we must get patients to -0.75 D before the Kamra inlay is implant- ed. The result is that patients are able to maintain their near vision even longer (Figures 3 and 4). CONCLUSION The thing we like most about the Kamra inlay is that it does not induce mini- monovision and, therefore, does not hurt distance vision. Rather, the Kamra inlay can enhance near vision and slightly improve distance vision at the same time. I believe that the Kamra inlay provides us with the best opportunity to get away from monovi- sion and to give our patients near without sacrificing the distance. n Figure 4. Patients achieve predictable, stable near vision after Kamra inlay implantation. R. LUKE REBENITSCH, MD MICHAEL B. WILCOX, MD n [email protected] n [email protected] n Financial disclosure: Lecture fees (AcuFocus) n Financial disclosure: None acknowledged Q: How many Kamra inlays have you implanted? Q: How many Kamra inlays have you implanted? A: I have personally done about 210 inlays. A: I have personally done 75; in total in our practice, we have done about 200. Q: What are you able to achieve on average for near and far acuity? Q: What are you able to achieve on average for near and far acuity? A: On average, we expect a monocular uncorrected distance visual acuity of A: On average, in patients with a -0.75 D refraction prior to implantation, 20/25, and we expect the same for monocular uncorrected near visual acuity as monocularly they should achieve 20/25 at distance and J1 at near.
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