Review of Presbyopia Treatment with Corneal Inlays and New Developments

Majid Moshirfar,1– 3 Marshall K Henrie,4 Carter J Payne,5 Briana K Ply,1 Yasmyne C Ronquillo,1 Steven H Linn,1 Phillip C Hoopes1 1HDR Research Center, Hoopes Vision, Draper, UT, USA; 2John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; 3Utah Lions Eye Bank, Murray, UT, USA; 4University of Utah School of Medicine, Salt Lake City, UT, USA; 5Case Western Reserve University School of Medicine, Cleveland, OH, USACorrespondence: Majid Moshirfar, HDR Research Center, Hoopes Vision, 11820 State St, Draper, UT, USA, Email cornea2020@icloud.comAbstract: Presbyopia may represent the largest segment of refractive errors that is without an established and effective refractive surgery treatment. Corneal Inlays are materials (synthetic or allogenic) implanted in the stroma of patients’ corneas to improve presbyopia. These inlays, introduced into the United States in 2015 via the small-aperture corneal inlay (KAMRATM, SightLife Surgical/CorneaGen, Seattle, Washington, United States), were met with an initial wave of enthusiasm. Subsequent models like the shape-changing corneal inlay (RAINDROPTM, Revision Optics, Lake Forest, California, United States) offered excellent results for patients, but longer-term research raised questions about patient safety. At the time of this article, no synthetic corneal inlays are available in the United States for the correction of presbyopia. Other options for presbyopia correction include allograft corneal inlays, trifocal synthetic corneal inlays, pharmacologic therapies, scleral incisions or additive techniques and PresbyLASIK. Presently, allograft inlays consist of corneal lenticules removed from patients undergoing Small Incision Lenticule Extraction (SMILE). We will review corneal inlays and other alternative procedures that may provide effective and predictable treatments for patients with presbyopia.Keywords: corneal inlay, corneal onlay, SMILE, PEARL, PresbyLASIK, refractive surgery, KAMRA, raindrop, flexivue, corneal allografts, presbyopic allogenic refractive lenticule