The KAMRA Corneal Inlay- This Surgeon’s Initial Observations

Having completed my initial series of pocket Kamra inlay cases, I now find myself well along on the presby surgery learning curve. One quickly learns the process of selecting candidates for surgery and managing post-operative courses and expectations. The KAMRA technology is an animal with many moving parts all of which require strict attention. Candidates should have a low level of optical scatter as determined by the Acutarget HD and a mildly myopic refractive error (-0.50 to -0.75) with neglible levels of astigmatism or higher order aberration. Prospective patients in this KAMRA “sweet spot” appear to benefit most from the small aperture optics following inlay surgery and are also likely to tolerate small degrees of aperture decentration (1). Those who present outside of this acceptable range are best pre treated with custom excimer PRK or LASIK procedures or considered for combined inlay procedures (prKAMRA or sbKAMRA). Candidates must be carefully evaluated for any sign of tear film dysfunction making use of all available clinical modalities including the Acutarget HD tear film function metric as even the mildest degree of surface dryness will lead to poor KAMRA outcomes and therefore punctual plugging, postoperative Restasis and tear film supplementation is essential. If the KAMRA femtosecond pocket is fashioned with its side cut too far anterior there is risk of generating against the rule astigmatic refractive errors that will need to be addressed.

Approximately 25% of patients will enjoy immediate benefits from KAMRA implantation at all ranges of vision while the majority will note immediate improvement at near and intermediate ranges while improvement in the distance lags and can require up to two months to stabilize as the corneal pocket heals.


When all the moving parts of KAMRA are well managed this depth of focus enhancing corneal inlay delivers sheer joy in the recipient as demonstrated in the written commentary provided by one of our post-ops.


8 weeks post Kamra Inlay surgery and the latest chance to show off my remarkably improved reading vision (Look mom no glasses!) came Wednesday night when my wife and I cooked dinner on our new countertop grill for the first time. The tiny text in the troubleshooting chart, as well as elsewhere in the grill’s instruction booklet, actually proved no trouble at all as I started reading parts aloud–although in doing so I realized I was playing to an audience of one already well familiar with my highly augmented abilities. And as we grilled simple salmon burgers I couldn’t help but wonder if I’d have gotten more of a response preparing one of the recipes in the back of the booklet, which were set in even smaller type. A bigger recent challenge for me, though, was the online IRS handbook I referenced Thursday afternoon, and while it did indeed prove “taxing” I was still able to clearly “deduct” just about every line. Meantime, I now seem to be gaining greater endurance when tackling such content, becoming less prone to eye strain and other side effects. Still, with every gain, I tend to push my eyes further, leading inevitably to some level of discomfort–and not only in my left eye (the one with the Kamra Inlay) but sometimes both. I don’t want to minimize the ramifications of this distress as it’s forced me to greatly limit the amount of computer and other work I’ve been able to handle plus how m8 weeks post Kamra Inlay surgery and the latest chance to show off my remarkably improved reading vision (Look mom no glasses!) came Wednesday night when my wife and I cooked dinner on our new countertop grill for the first time. The tiny text in the troubleshooting chart, as well as elsewhere in the grill’s instruction booklet, actually proved no trouble at all as I started reading parts aloud–although in doing so I realized I was playing to an audience of one already well familiar with my highly augmented abilities. And as we grilled simple salmon burgers I couldn’t help but wonder if I’d have gotten more of a response preparing one of the recipes in the back of the booklet, which were set in even smaller type. A bigger recent challenge for me, though, was the online IRS handbook I referenced Thursday afternoon, and while it did indeed prove “taxing” I was still able to clearly “deduct” just about every line. Meantime, I now seem to be gaining greater endurance when tackling such content, becoming less prone to eye strain and other side effects. Still, with every gain, I tend to push my eyes further, leading inevitably to some level of discomfort–and not only in my left eye (the one with the Kamrauch down time I’ve sometimes needed afterwards. But these limitations are diminishing, as is the fallout when I overdo. And while such restrictions are frustrating, they pale in comparison to the benefits I expect to achieve when I’m fully healed as I’m already a long way there in my battle against Presbyopia, and to my best guess rounding the final turn before heading on to the finish line!

Author
Dr. Fox

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