Corneal inlays: Another entrant into the presbyopia treatment wars

Implications: The early results of a new corneal inlay (PresbyLens, ReVision Optics) are presented.  A corneal inlay is placed underneath a LASIK corneal flap in the non-dominant eye to correct presbyopia.  This version of a corneal inlay is 1.5mm in diameter.  The outcomes of 15 patients showed good uncorrected distance and near vision with 86% with 20/40 or better uncorrected near vision and 64% with 20/40 or better uncorrected distance vision.

Analysis: This version of a corneal inlay joins several other corneal inlays currently in clinical trials.  Inlays from AcuFocus and Biovision incorporate a pinhole to improve near vision by increasing depth of field.  On first glance the early clinical results of the Presbylens corneal inlay do not seem impressive compared to those of AcuFocus.  The AcuFocus corneal inlay began clinical trials in February, 2006.  The Acufocus results on a cohort of 34 patients from Istanbul presented before the clinical trials began showed most patients achieving 20/20 vision and J1 reading vision.  Of note, Bausch and Lomb has made a major investment in Acufocus and is betting that this inlay will become the treatment of choice.

With a potential market of 141 million, the entry of another corneal inlay into the presbyopia treatment area speaks to the fact that this area is very hot.  When compared to other presbyobia treatments, corneal inlays have several advantages including reversibility, limited decrease in distance vision, and ease of implantation.  While the Presbylens may not be a winner in this area, corneal inlays are a treatment option certainly worth watching.