Corneal Inlays: A Surgical Alternative to Reading Glasses

As you enter your 40s and 50s, chances are that you will have a little more difficulty reading a book or seeing your phone’s screen up close. This is a symptom of a common, age-related eye condition called presbyopia. Presbyopia is caused by a stiffening of the eye's lens, which gradually weakens the ability to focus on near objects. Until recently, the most common treatment options for presbyopia were eyeglasses, contact lenses or laser vision corrective surgery.

Today, corneal inlays offer an alternative to wearing reading glasses. They are implanted in the eye with a minimally-invasive surgical procedure, restoring close-up vision. Your ophthalmologist will help you determine whether you are a candidate for a corneal inlay and which type may be your best fit.

What Are Corneal Inlays?

A corneal inlay is a tiny device, smaller than the width of an eraser tip. During a 10-15 minute surgery, a laser is used to cut a small pocket or flap in the middle of the non-dominant eye’s cornea. The inlay is then inserted into or under this pocket or flap, depending on which inlay is used. The implant corrects close-up vision by increasing the depth of focus of the center of the cornea.

There are two main types of corneal inlays, which look and work a little differently. One of them is now FDA-approved for use in the United States.

Refractive Corneal Inlays

The design of refractive corneal inlays is similar to a multifocal contact lens or intraocular lens, with different areas of the inlay giving different levels of magnifying power. This allows the eye to focus up close and far away. This type of inlay is currently under review by the FDA.

Small Aperture Inlays

Small aperture inlays work like the aperture of a camera, changing how much light enters the eye. This device is a donut-shaped ring with a pinhole opening in its center. The pinhole focuses light very specifically into the eye, narrowing the field of vision. This provides better sight at close range. The KAMRA is the first small aperture inlay approved by the FDA (in April 2015) for use in the United States.

Some things to know about corneal inlays:

• Corneal inlays are usually implanted in people with presbyopia who don’t have refractive errors (like myopia, hyperopia, or astigmatism). For people with refractive errors, a “combination” procedure can be done—doing LASIK to fix the refractive error at the same time the inlay is implanted. Some of these combination procedures are considered “off-label” use of corneal inlays. The FDA allows “off-label” use of a treatment if doctors are well informed about the product or procedure, and studies prove it is helpful.
• If you want corneal inlays, you need to be free of disease of the cornea, like keratoconus (cone-shaped cornea).
• Patients with uncontrolled dry eyes or blepharitis should not get corneal inlays unless these conditions are treated.
• Patients with cataracts should not get corneal inlays.
• For some corneal inlays, you need to have a test to be sure your cornea is thick enough for the surgery.
• Corneal inlays are usually inserted into one eye only (your non-dominant eye).
• You will be awake during the surgery but it will be done under local anesthesia (inducing loss of sensation to prevent any pain).
• After surgery, patients should expect to use antibiotic and steroid eye drops for up to a month.
• Depending on the type of corneal inlay, there can be side effects like glare, halos and difficulty seeing at night or reading in dim light. Other potential complications include corneal scarring, swelling, inflammation, thinning of the cornea, clouding of the cornea. Ask your ophthalmologist about the side effects of your corneal inlay.
• Corneal inlays can be removed if you are not satisfied with the results.