Know about corneal inlay

Medically reviewed by Tina Patel, Contact Lens Optician at Feel Good Contacts.

Here’s a short guide for you on corneal inlays:

What is a corneal inlay surgery?

Corneal inlay surgery is when a tiny device is inserted in the middle of the cornea, mostly to treat presbyopia. Presbyopia is an age-related eye condition where the eyes loses its ability to focus on nearby objects. People over the age of 45 generally experience this refractive error which is the result of a natural aging process. As the lens of the eye hardens and deteriorates, with time, it becomes harder to focus on things near-by.

A corneal inlay helps in improving near visual acuity and the depth of focus, which eventually makes it easier to look at things closer to you, such as when reading a newspaper. This process is usually performed on of the non-dominant eye under topical anaesthesia.

This surgery is generally for people with presbyopia. Although presbyopia can be corrected with prescription glasses or contact lenses, but a corneal inlay is thought to be more advantageous and convenient for those who do not like wearing any optical aids.

Corneal inlays for presbyopia, as convenient as it sounds is a bit expensive compared to laser eye surgery. Cost of corneal inlay will differ for service to service and what inlay are you opting for. Although it is generally safe, it’s important to review the downsides too, just to be sure. The best practice would be discussing the advantages and disadvantages of this surgery with your ophthalmologist.

Types of corneal inlays

There are two types of corneal inlay:

1. Refractive corneal inlay

The design of this inlay is similar to a multifocal contact lens or an intraocular lens. It can help the eye focus both near and far, providing different levels of magnifications, depending on different areas of the inlay through which the light will pass.

2. Small aperture inlays

This device looks like a ring, with a tiny pinhole opening in the centre. A simple analogy for this inlay device would be - think of aperture of a camera, similar to that, small aperture inlay works by controlling the amount of light that enters the eye, narrowing the field of vision. As so, providing better near vision.

Currently KAMRA and Presbia Flexivue Microlens inlays are some of the few being utilised to eliminate the need of contacts or glasses and improve the near vision. The type of corneal inlay to be used will be decided by your ophthalmologist depending on the level of presbyopia.

Who can benefit from this surgery?

Generally, this surgery is recommended for those suffering with presbyopia, i.e., people over 40 years of age. This surgery requires the patient to have fairly healthy eyes beyond presbyopia. For instance, a variety of eye conditions, such as cataracts can bar you from opting for this surgery. Similarly, you cannot have uncontrolled dry eyes or blepharitis in order to get corneal inlay.

Although people below the age of 40 can also opt for corneal inlay surgery (refractive conditions such as myopia and astigmatism can be corrected), but the process is a bit tricky. In such cases, first LASIK eye surgery is used to correct the refractive error and then a corneal inlay surgery can be carried out. LASIK eye surgery or Laser-assisted in situ keratomileusis is the most commonly performed laser surgery to correct vision problems.

What happens in the corneal inlay surgery?

This surgery is a 15-minute process which is operated on the non-dominant eye. The surgery is operated monocularly, meaning, only one eye will have an inlay is inserted. The patient will be awake throughout the surgery and will be given topical anaesthesia. A laser is then used to cut a small pocket in the middle of the cornea. Depending on what inlay your ophthalmologist suggested, the inlay will either be inserted under or onto the cut pocket.

For some people to get corneal inlay surgery, they might need to go for a test to ensure their cornea is thick enough to go through the process.

What can you expect after this procedure?

After the surgery you will be prescribed with the use of antibiotic and steroid eye drops for at least a month.

You might experience the following complications after your surgery. In such cases, you must discuss this with your ophthalmologist at the earliest.

  • Reduced quality of vision
  • Blurry vision
  • Fluctuating vision
  • Flare or halos around light
  • Infection/irritation in the eye
  • Difficulty seeing things at night

Please note that, if you’re unhappy with your inlay, you can get them removed. However, that can cause additional complications.

Are corneal inlays safe?

When asked this question, Tina Patel, Contact Lens Optician at Feel Good Contacts said that, “Corneal inlays are thought to be a safe option but just like any other surgery it does not come without any risk factors. Sometimes complications can lead to serious eye damage. Although the process is reversable, it can come with added complications. Some might benefit immensely with this surgery, for others it might come with some down sides”.

If you are considering this as an option, it is important to find out whether getting corneal inlays would be a suitable option for you or not. The best practice would be to discuss this with your ophthalmologist and also ensure if you’re going for the surgery, all the measurement for the inlay(s) are correct to reduce the chances of errors.

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