Physician-patient receives corneal inlay in his own eye

Take-Home

A surgeon undergoing implantation of a corneal inlay to treat presbyopia enjoys the same visual benefits as his patients with the device.

By Lynda Charters; Reviewed by Jeffrey Machat, MD, FRSCS

Toronto-Turning the tables to become a corneal inlay patient himself, Jeffrey Machat, MD, FRSCS, underwent implantation of the presbyopic device (Kamra, AcuFocus) in his own eye.

Dr. Machat noted he was delighted with the excellent results at all levels of vision.

In addition, his results were very similar to the mean results of his patients who opted for implantation of this corneal inlay, said Dr. Machat, chief medical officer, Crystal Clear Vision Canada, Toronto. Minoru Tomita, MD, from Shinagawa Clinic, Toyko, performed Dr. Machat’s procedure in August 2012.

The device is implanted in a pocket in the cornea over the center of the pupil. The inlay works by narrowing the pupil to form a concentrated ray of light. This results in movement of the focal point onto the retina.

The corneal inlay can be implanted using three types of procedures. In Dr. Machat’s practice, a total of 117 eyes have received the corneal inlay since March 2013. Specifically, the pocket emmetropic Kamra (PEK) procedure has been performed in 18 eyes, a combined LASIK Kamra procedure has been done in 13 eyes, and a post-LASIK Kamra (PLK) or planned two-step post-LASIK Kamra (PLK2) procedure has been performed in 86 eyes.

In PLK2, Dr. Machat treats patients with various degrees of myopia, hyperopia, and astigmatism with LASIK, targeting plano in the dominant eye and –0.50 to –0.75 D in the non-dominant eye, and once at the ideal refractive outcome, inserting the inlay in the non-dominant eye.

The 117 eyes in his practice with the corneal inlay achieved markedly improved levels of vision. The mean uncorrected visual acuity improved from a baseline level of J8/J9 to J1 by 3 months postoperatively. Uncorrected distance visual acuity (UDVA) improved from a mean of 20/50 preoperatively to 20/20 by 3 months postoperatively. The mean manifest refraction spherical equivalent (MRSE) 3 months postoperatively was –0.81.

Undergoing the procedure

In Dr. Machat’s case, he underwent the PEK procedure.

Before the procedure, Dr. Machat’s uncorrected near visual acuity was J5/J6, UDVA was 20/40, and MRSE was –0.75 D.

Six months after surgery, the respective values were J1+, 20/25, and -0.75 D, he reported. When he compared his outcomes with those of the global PEK registry, the mean 6-month data from 131 eyes were about J3, 20/15, and 0.06 D.

Seventeen months later, Dr. Machat has maintained both his near and distance visual acuity and his qualitative vision continues to improve.

“My . . . patient outcomes mirror my personal experience with the [corneal] inlay,” he said. “However, my visual recovery was faster than that of most of my patients.

Dr. Machat noted that the benefits of this procedure in his mind are fourfold:

“I am not sacrificing my distance vision and I feel balanced.”

“I have good near and intermediate vision as well as good distance vision.”

“The small-aperture optics will not result in any loss of efficacy as my presbyopia advances.”

“And, finally, the reversibility of the procedure provides me with a level of safety.”

Jeffrey Machat, MD, FRSCS

E: jeff.machat@crystalclearvision.com

Dr. Machat has no financial interest in the technology.