New surgical procedure for presbyopia

by | July 6, 2010

No more relying on glasses, there is now an alternative option.

BY: Eleanor Yap


With the ageing population increasing, more people when they reach 45 will need help focusing on near objects as they will be suffering from a condition called presbyopia, also known as ‘lau hua’. Though the common solution is a pair of reading glasses, there is now a new surgical procedure called Kamra corneal inlay.

We talk to Professor Donald Tan, medical director of the Singapore National Eye Centre (SNEC), to find out more about this procedure:


Can you explain presbyopia?

Presbyopia affects people aged 40 and beyond. It comes with the normal ageing process and it reduces the ability of the eye to focus on near objects. By the time you reach age 45, you will need help. You are likely to face difficulties in focusing on near objects such as the printed text on a newspaper, price tags and SMSes on your mobile phone.


Before Kamra came along, what procedures could one go for?

The surgical treatments for presbyopia include monovision Lasik where one eye is corrected for far vision and the other for near vision. There is also presbyopic Lasik, where the surgery changes the shape of the cornea to give it more than one point of focus for distance and near vision. However, these procedures do have side effects or they do not fix the condition permanently. For instance, with presbyopic Lasik, there are decreased contrast sensitivity and night vision disturbances.


When was Kamra introduced in Singapore?

This long-term treatment has been available here since last June and it originated from the US. Clinical trials were first conducted in 2003. Here in Singapore, there was a three-year study by the Singapore Eye Research Institute (SERI) and the SNEC, and the results were successful with more than 60 patients from SNEC experienced improved functional near vision after having their presbyopia treated with the use of a similar type of corneal inlay.

This was part of a worldwide multi-centre trial which included eye institutions from the US, Europe as well as Australia. This procedure is safe and effective. (EDITOR’S NOTE: Kamra is still not approved by the US Food and Drug Administration.)


Can you explain the procedure?

It starts with anaesthetic eye drops onto the eye. A flap or pocket incision is created with a laser, similar to the Lasik procedure. The eye surgeon then inserts and centres the corneal inlay (a tiny black ring of 3.8mm in diameter and smaller than a contact lens, shown below) in the cornea of the eye, under the flap. The whole procedure takes less than 20 minutes.

Simply put, the hole in the centre of the ring makes the pupil smaller, the aperture or opening will increase the depth of field of the eye and improve the range of vision. Also, only one eye (non-dominant one) is implanted to minimise discomfort.

The benefits of Kamra corneal inlays are permanent but there is a safety net in that the procedure is reversible and the inlay can be removed.


How much does it cost?

The procedure alone costs from $4,140. (EDITOR’S NOTE: This costs more than other surgical treatments for presbyopia, which typically costs from $1,500 an eye.)


What are some side effects?

Some patients have experienced some degree of dry eye, glare and halo at night. (Halo is when bright objects like a car’s headlights appear blurry against a dark background.) Some patients also notice slightly dimmer distance vision in the implanted eye, but this is compensated for by the other eye, which is their master eye.  Some patients also have some minor changes in their degree over time, which is thought to be partly related to dry eyes, and this appears to be reversible with eye drops.


So how many patients have you treated so far and how many have asked for it to be removed and why?

There were over 80 cases performed and only two removals. Removals in general are because of unrealistic expectations by patients, the side effects and complications, which are oftem rare and temporary. 


Any other eye centres who are doing this new procedure or are you the first? 

Several other centres in Singapore are very keen and have approached the company and us to help train them. We are in the midst of doing so. Progress has been slow because of limited availability of the implants from the company due to large demand elsewhere, for example, in Japan and Europe.


Are there some patients who are unable after assessment to have this procedure? Explain?

Definitely. Many have the same contra-indications like Lasik (thin corneas, other eye problems, etc). Because this device largely reduces dependence on reading glasses, but may not be able to get patients off reading glasses totally (especially when reading in dim light conditions), we do have patients who have undue expectations, for whom we do not recommend this treatment.


How long will the patient’s vision improve after the procedure?

The treatment is permanent, and patient’s vision continues to improve for several months, up to even six months. However, if the visual result does not meet overall expectations, it can of course be removed.



Forty-eight-year-old Jo Yong, brand general manager of Estee Lauder, had the Kamra corneal inlay procedure in January this year at the Singapore National Eye Centre (SNEC) and has praises for it. She even said, “Frankly, without reading glasses, no one could guess my age.” Agelessonline speaks to the mother of two about her experience:

When did you get presbyopia?
At age 45.

What made you decide to try this new treatment? 
Convenience! Imagine you can read and reply SMSes, read price tags, shopping labels and restaurant menus without reading glasses!

How did you hear about the new treatment?
From news report on TV.

Did you try the other treatments first like presbyopic Lasik? 

What concerns did you have initially? 
No concerns at all. I trust the SNEC.

After the treatment, did you have any side effects? 
I experienced dry eyes and have to use eye drops often.

How has the treatment improved your life? 
I am always on the go so without having to rely on reading glasses is just great!

Anything else to add?
I would definitely encourage anyone who needs it.



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