The surgical correction of presbyopia is one of the hot topics of refractive surgery. For this reason, we have read with great interest the article by Vilupuru and associates, recently published in the American Journal of Ophthalmology . The authors should be congratulated because this is the first report that evaluates the contrast sensitivity and the visual outcomes of KAMRA intracorneal inlay and compared them with 3 intraocular lenses (IOLs) (accommodating or multifocal) for the treatment of presbyopia.
However, we have concerns about 2 facts of this study. First, when reading the methods, we have observed that the patients included in the KAMRA group had a preoperative spherical equivalent of +0.50 diopter to −0.75 diopter. Given the fact that a mild myopic defect can partially compensate presbyopia, we believe that the visual outcomes reported in the KAMRA group may have been overestimated; that is, the improvement in intermediate and near vision in those patients with myopia would be explained, at least in part, by the myopic defect in the nondominant eye (monovision-like situation) and not by the KAMRA performance in itself.
Second, the main conclusion of the study is that KAMRA inlay provides better results than premium IOLs in terms of contrast sensitivity and distance and intermediate vision. Nevertheless, we have previously reported the visual outcomes of LASIK-induced monovision, another widely used method for the correction of presbyopia, and it is remarkable that our results are comparable to those reported by Vilupuru and associates in the KAMRA group. For this reason, we do not see the real benefits of the KAMRA inlay compared to simple monovision. In fact, the authors suggest that a potential advantage of the KAMRA inlay is its easy removability compared to an IOL exchange if the patient is dissatisfied. Nevertheless, several cases of moderate to severe loss of best-corrected visual acuity have been reported after intracorneal inlay explantation, due to epithelial perilenticular opacity. On the other hand, and in contrast with other techniques to correct presbyopia (such as intracorneal inlay, multifocal IOLs, or multifocal corneal laser ablation), a patient with LASIK-induced monovision can easily improve the distance or near vision for certain tasks by wearing glasses.
For all these reasons, we believe that further studies are needed to ensure the real advantages and disadvantages of the various procedures currently available for the surgical treatment of presbyopia.