the optics and vision of kamra vs. raindrop inlays · kamra case report •49 y/o with desired...

The Optics and Vision of

KAMRA vs. Raindrop Inlays

R. Luke Rebenitsch, MD

Refractive Surgeon

Wavefront Congress

February 24, 2017

Disclosures

• Acufocus

• Ziemer

• Staar Surgical

• Wavefront Congress

• Refractive Surgery Alliance

Outline

1) Optics of each inlay

2) IDE results

3) Personal results and case reports

4) Current considerations

KAMRA Inlay

• PVDF inlay with central hole and without refractive power

• Increased depth of focus through small aperture optics

• Location: 200-250μcorneal pocket

Raindrop Inlay

• Transparent hydrogel inlay without refractive power

• Increased depth of focus through profocal(hyperprolate) cornea

• Location: Underneath 30% corneal thickness flap

KAMRA Small Aperture Optics

Raindrop Profocal Cornea

through Epithelial Remodeling

Raindrop Refractive Inlay Effect

• Steinert RF. Range of refractive independence and mechanism of action of a corneal shape-changing hydrogel inlay: results and theory. J Cataract Refract Surg. 2015 Aug;41(8):1568-79

Results from the KAMRA US IDE

• An average 3 line gain at 12 months was achieved and sustained over the duration of the study

• Achieved results remain stable over the 36 month follow-up

Effect of Refraction on KAMRA

Visual Outcomes

Raindrop Course and Stability

Average Change in Uncorrected

Acuity at 24M with Raindrop

Personal KAMRA Experience

over the first ~100 KAMRA

inlays

Raindrop Case Report

• 50 Y/O desiring computer and phone vision without loss of distance vision

• Pre-op MRx

– OD: +0.25 +0.50 X 020 = 20/20

– OS (Dominant): +0.75 Sph = 20/20• UNVA: 20/80

• Post-Op OD Monocular Visions

– Monocular UDVA = 20/12

– Monocular UNVA: 20/25

SA: 0.174 SA: -0.172SA: -0.617

Pre-OP Week 1 Month 3

KAMRA Case Report

• 49 Y/O with desired improved computer and reading vision without loss of distance

• Pre-op MRx

– OD (dominant): -0.25 Sph =20/20

– OS: Pl=20/20• UNVA: 20:80

• Post-OP LASIK OS and KAMRA OS

– Monocular UDVA: 20/25

– Monocular UNVA: 20/20

Current Considerations

KAMRA

• Combined procedures to achieve ideal refraction of -0.75

• Centration - ↑Importance

• Deeper Pockets

• Role of MMC?

Raindrop

• Combined procedures to achieve ideal refraction of ~+0.25

• Centration – ↓Importance?

• Pocket versus Flap

• Role of MMC?

Conclusion

• Both corneal inlays achieve excellent and similar uncorrected near vision with minimal loss of uncorrected distance vision

• Attention to detail and understanding of the optics of each inlay is necessary to achieve ideal results

Thank you